Barry recently had an MRI and the result were not what we were hoping and praying for. Dr. Maher, Barry's Neuro-oncologist, said that the MRI that he had on Wednesday showed that the tumor (the same one that was initially removed during surgery) has started to grow again. She said that there was some bleeding around the tumor which is causing the pressure that he has been experiencing, resulting in the return of his headaches. The headaches are not as frequent as the last time he had new tumor growth and he is only taking one pain pill a day, sometime two. Overall, he feels really good and is mentally clearer than Brant and I have seen him in a long time.
The news hit him hard on Wednesday. We both thought that it would be more of the same news, slight shrinkage, but he has accepted the news as "part of it" in his words. He has promised me that he is not going to let this get him down and will continue to fight and maintain a positive attitude. Yesterday, he talked to Dennis on the phone for a while and conveyed a very positive attitude about moving in a different direction with the new treatment. He is an AMAZING man with such great courage and determination to beat this. In fact, he and I went to our friends gym yesterday and had a great workout. It lifted his spirits tremendously to be back in a gym setting.
The new treatment consists of three new drugs (listed below with information on each). The only really negative side effect for Barry will be in the first two weeks of taking Thalidomide. Dr. Maher said that it would make him extremely tired, so tired in fact, that we may have to wake him just to get him to eat during that time. After that, the intense fatigue wears off and he is better able to tolerate the medication. (30% of patients on this drug saw the tumor completely shrink, 60% of patients, the tumor stays the same and does not continue to grow, the remaining patients did not respond)
We love you all so much and thank you for your continued prayers and support.
Love you all,
Kari
Thalidomide was used widely outside of the United States as a hypnotic/sedative agent in the late 1950s and the early 1960s, but was withdrawn from the market because of the high incidence of severe birth defects attributed to this drug. Thalidomide was never approved in the US until recently, when it was approved for use in the treatment of leprosy-related conditions. However, there has been renewed interest in thalidomide over the past several years, particularly in the treatment of AIDS-related conditions, cancer and HIV-induced wasting, complications of leprosy, and bone-marrow transplant related graft-versus-host disease. These effects were attributed mostly to specific inhibitory activity on tumor necrosis factor-alpha (TNF-alpha) production.
Observations that thalidomide is also an inhibitor of angiogenesis (prevents formation of new blood vessels in tumors) has prompted investigations of its use in the treatment of cancer. In order for a rapidly growing tumor to maintain its growth, a tumor "signals" already existing blood vessels to sprout new branches to feed it. Without a supply of oxygen and other nutrients, tumor growth would be impaired. As a tumor continues to grow, additional blood vessels would need to be formed to sustain new areas of tumor growth.
Clinical trials of thalidomide as a single agent in malignant gliomas that have recurred following radiation therapy have shown evidence of that this drug is active and can produce responses. Thalidomide is currently being tested in combination with a chemotheraputic agent active in malignant gliomas (carboplatin), and single-agent clinical trials are being initiated in the treatment of recurrent brain metastases and in the treatment of recurrent atypical or malignant meningiomas.
Thalidomide is an oral agent. In the ongoing clinical trials for gliomas, meningiomas, and brain metastases, it is taken as a single dose at night. The dose administered is dependent on the trial and is based on body surface area. Toxicities are usually dose-dependent and include drowsiness and constipation (most common) as well as rash and neuropathy (nerve damage) in the arms and legs. The most serious toxicity is the damage that thalidomide can produce in a developing fetus. All women receiving this drug require monthly pregnancy tests (unless not medically necessary). All men and women receiving thalidomide are required to use at least two forms (barrier and hormonal) of contraception.
Dexamethasone Brain tumor-associated cerebral edema arises because tumor capillaries lack normal blood-brain barrier function; vascular permeability factor (VPF, also known as vascular endothelial growth factor, VEGF) is a likely mediator of this phenomenon. Clinically, dexamethasone reduces brain tumor-associated vascular permeability through poorly understood mechanisms
BCNU is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug. BCNU is classified as an "alkylating agent." (For more detail, see "How this drug works" section below).
What BCNU is used for:
Used to treat certain types of brain tumors; glioblastoma, brainstem glioma, medulloblastoma, astrocytoma, ependymoma and metastatic brain tumors.
Other cancers treated with BCNU include multiple myeloma, Hodgkin's disease, non-Hodgkin's lymphomas, melanoma, lung cancer, colon cancer.
How BCNU is given:
BCNU is usually given by an infusion into a vein (intravenous, IV).
There is no pill form of this medication.
There is a form of this medication (Gliadel® wafer) that can be placed and left in the cavity after surgical removal of a brain tumor. The carmustine wafer allows for delivery of the drug directly to the site of the brain tumor. (See separate listing "carmustine wafer" for more details regarding this formulation).
The amount of BCNU that you will receive depends on many factors, including your height and weight, your general health or other health problems, and the type of cancer or condition being treated. Your doctor will determine your dose and schedule.
