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Thread: Unusual GBM DNA Sequencing

  1. #1
    Senior User
    Join Date
    Jul 2015
    Location
    Central MA
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    Unusual GBM DNA Sequencing

    Well this one is certainly different. They did surgery to remove a GBM metastatic tumor from my son's lower spine. When the DNA sequencing came back, there were over 20 different mutations. It turns out this is related to the deletion of a mismatch repair gene, known as an MSH6 deletion. They only find this after the "gold standard" treatment, as it has something to do with the way Temodar acts with the tumor which actually causes it to mutate and metastasize. While they think this deletion may be responsive to Keytruda and/or Opdivo, they cannot start it now because of radiation for the spinal metastases, which is wiping out his white blood cell count.

    In addition to that, on Wednesday he had another MRI because of unusual headaches and they found two additional tumors alongside the original resection cavity, too small to be operable. They may be able to do cyberknife down the road, but want to start systemic therapy first. They started Avastin yesterday, and will do CCNU (Lomustine) in conjunction with that once the white cells recover, and then move on to Keytruda or Opdivo, pending insurance approval. This is going to to be a long haul.

    Mike
    Last edited by mikeg; 07-16-2017 at 01:02 PM.
    DOB 1961
    Initial PSA June 2015: 30.47, Free PSA 6%
    Biopsy June 2015: 14 of 18 cores G7 (4+3), 2 of 4 cores G8, revised to G7 by Mass General, negative scans
    Laparoscopic (non-robot) RP done 7/21/15
    Path Report:
    Stage T3B, N0, M0
    Gleason 7 (4+3) with 5% tertiary 8 (5+3)
    Lymph nodes negative
    Margins: 2mm at the ink
    EPE, SVI, LVI, PNI all present
    3 month post-RP PSA 10/15 0.17, same 11/15
    Lupron and AR treatments 3/16, PSA <0.10 5/16, 8/16, 2/17

    Son diagnosed with GBM4 12/18/15. Surgery at MGH full resection followed by 33 days of radiation and 42 of Temodar, finished up 3/15/16. Seizure 1/9/17, on 1,000mg daily Keppra. "Stupp Protocol" finished 4/17 (after 12 months). MRI's clear through 2/17. May 2017 showed recurrence at L4 with more inoperable lesions. Successful spine surgery 5/17, rain and additional spinal recurrence 7/17, Avastin started. Spinal radiation finished 7/28/17. 8/17 spinal lesions resolved. Keytruda started mid-September.

  2. #2
    Super Moderator Top User
    Join Date
    Dec 2011
    Location
    USA
    Posts
    4,418
    Oh, man. Just one thing after another.
    At least the fact that they think they can do cyberknife is good news...

 

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