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Standard Treatment for Newly Diagnosed High Grade Gliomas

Depending on your type of brain tumor, your provider may recommend radiation, chemotherapy or both of these as part of your treatment. Radiation is delivered to the area of the brain where the tumor is or the area where it was before surgery. Chemotherapy, particularly Temador (temozolomide), reaches this same area by going through the blood stream and then into the brain. Many times, radiation and chemotherapy are combined for an additive effect and to produce better treatment results. Your treatment plan will be discussed with you in detail. The standard therapy for a glioblastoma multiforme (GBM, grade IV tumors) is outlined below. The same treatment is frequently prescribed for anaplastic (AA, grade III tumors) as well.

Standard treatment for glioblastoma multiforme ( and also many grade III tumors) is based on the Stupp Protocol published by the New England Journal of Medicine, 2005. This consists of:

  1. Six week of radiation treatment
    5 days per week (Monday - Friday)
  2. Combined with 6 weeks of oral chemotherapy (Temodar also called temozolomide)
    7 days per week (Monday - Friday)
  3. This is followed by a four week break from treatment  (no radiation or chemotherapy)
  4. Then six more months of Temodar ONLY
    5 days per month

Remember, this is the standard treatment outline. You may be participating in an experimental trial/study which may add other medications or modalities to your treatment plan. These trials/studies may also prolong the length of time you are taking a particular drug. If you are participating in such a trial/suday, this information will be explained to you during the discussion of the trial/study.

Types of Chemotherapy for High Grade Gliomas

Temodar (Temozolomide) - Oral Chemotherapy

  • Begins with the first day of radiation and stops with the last day of radiation, unless complications cause the Temodar to be stopped early.
  • Is taken 7 days per week (Monday - Sunday); weeken doses should be taken at the same time as doses taken during the week.
  • Like most chemotherapy drugs, it is very expensive. An average month of Temodar costs approximately $10,000.00 Most prescription plans cover Temodar with the usual co-pay. For some patients, the co-payment amount could still be quite high.
  • If you have difficulty paying for Temodar, our pharmacy liaison can help you to apply for drug assistance programs. Contact Deborah Cantey at 443-287-6366.

Avastin (Bevacizumab)

Avastin is approved for Glioblastoma (GBM) when taken alone in adult patients whose cancer has progressed after prior treatment. The effectiveness of Avastin in GBM is based on tumor response. Currently, no data have shown whether or not Avastin improves disease-related symptoms or survival in people previously treated for GMB. Avastin is a tumor-starving (or anti-angiogenic) therapy. The purpose of Avastin is to block a protein called vascular endothelial growth factor, or VEGF. Normal cells produce VEGF, but some cancer cells overproduce VEGF. Blocking VEGF may prevent the growth of new blood vessels that feed tumors.

Avastin is given as an infusion, meaning you recieve Avastin through a small needle in your vein or through a port. Because Avastin is given as an infusion, infusion reactions may occur. Avastin infustions will be stopped by your doctor or nurse if infusion reactions are severe.

Your doctor or nurse will monitor you for signs of an infusion reaction, which may include:

  • High blood pressure or severe high blood pressure that can lead to stroke
  • Difficulty breathing
  • Decreased oxygen in red blood cells
  • A serious allergic reaction
  • Chest pain
  • Headache
  • Tremors
  • Excessive sweating

Possible serious side effects can occur. Your doctor will stop treatment if any serious side effects occur. Be sure to contact your health care team if you have symptoms related to these side effects.

  • Gastrointestinal (GI) perforation. A hole that develops in your stomach or intestine. Symptoms include pain in the abdomen, nausea, vomiting, constipation or fever.
  • Wounds that do not heal. A cut made during surgery can be slow to heal or may not fully heal. Avastin should not be sued for at least 28 days before or after surgery and until surgical wounds are fully healed.
  • Serious bleeding. This includes vomiting or coughing up blood; bleeding in the stomach, brain, or spinal cord; and vaginal bleeding. If you recently coughed up blood or had serious bleeding, do not take Avastin.
  • Stroke or heart problems. These include blood clots, mini-strokes, heart attacks, and chest pain. These can sometimes be fatal.
  • Severe high blood pressure. Blood pressure that severely spikes or shows signs of affecting the brain. Blood pressure should be monitored every 2 to 3 weeks while on Avastin and after stopping treatment.
  • Nervous system and vision problems. Symptoms include high blood pressure, headache, seizure, sluggishness, confusion and blindness.
  • Kidney problems. These may be caused by too much protein in the urine and can sometimes be fatal.
  • Infusion reactions. These may include difficulty breathing, chest pains, and excessive sweating. Your doctor or nurse will monitor you for signs of infusion reaction.
  • Fertility issues for women. Avastin could cause a woman's ovaries to stop working and may impair her ability to have children.

Please see full product information, including serious side effects for additional and important safety information.



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