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 Post subject: Off the shelf drugs
PostPosted: Fri Oct 28, 2005 4:49 am 
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Joined: Sat Oct 01, 2005 10:20 am
Posts: 11
Location: Sunderland, England
Firstly I’d like to say what a great site this.

I’d also like to ask for some advice about some ‘off the shelf’ drugs which others may have used keen to use too and I’ll be discussing with my NO in the next few days.

The drugs which seem to be the seem most promising are:
Accutane
Celebrex
Chlorinique
Tamoxifen
Thalidomide

Others I’ve heard of but I’m not too familiar with include:
Avastin
Caelyx
Cimetidine
Clomipramine
Glitazones
Iressa, tarceva and erbitux
STI-571 (Gleevec)
Tarveca

There are some area which cause some concern:
Cost
Side effects
Effectiveness

Can anyone provide any enlightenment? Can anyone provide any information/summaries in addition to Ben Williams’?

Any advice would be greatly appreciated,
Chris


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 Post subject:
PostPosted: Fri Oct 28, 2005 7:35 am 
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Joined: Fri Jul 22, 2005 1:58 pm
Posts: 50
Location: Woodford, Queensland
Chris I can help you with some of them. Re celebrex, I take 400mg per day. For me the dose should be 800mg per day, but my GP was worried that the coroner risks at this level were too high. So he could prescribe celebrex, I told him I had sore knees from too much horse riding. We both new what was going on, but the little white lie gave him protection if he was audited. Did some thing similar with Cimetidine and I now take 800mg per day (Magicul Brand - a generic). Because I have no idea of how to attach word files, I will have to paste in what I have got.

As Uschi posted here http://www.btsurvivor.com/bb/viewtopic.php?t=51 the trial Celebrex dose was 480 mg/m2, which for Jane is about 800mg.

The mg/m2 equation is based on Body Surface Area (BSA) and a calculator can be found here:

http://www.halls.md/body-surface-area/bsa.htm


Phase I/II trial of a twice-daily regimen of temozolomide and celecoxib for treatment of relapsed/refractory glioblastoma multiforme and anaplastic astrocytoma.

Meeting: 2004 ASCO Annual Meeting

Category: Central Nervous System Tumors

SubCategory: CNS Tumors

Abstract No: 1549

Author(s): S. Pannullo, S. Hariharan, J. Serventi, R. Hayes, C. Balmaceda, J. Burton; JFK Medical Center, Edison, NJ; NYPH-Weill Cornell, New York, NY; Columbia Presbyterian Hospital, New York, NY; Staten Island University Hospital, Staten Island, NY

Abstract: Background: Combination therapy using agents with different mechanisms of action and non-overlapping toxicity may be a safe and effective strategy in cancer therapy. As seen in Phase I of this trial, BID temozolomide [Temodar (TMZ)] in combination with celecoxib (Celebrex) is a safe treatment regimen for malignant glioma. Phase II of this clinical trial tests the hypothesis that celecoxib combined with a BID schedule of TMZ is a more effective therapy for recurrent/progressive malignant glioma.

Methods: Patients received a loading dose of 200 mg/m2 of TMZ followed by 9 doses of 90 mg/m2 TMZ BID for 5 days of every 28 day cycle. Celecoxib was given to a maximum dose of 480 mg/m2 for 10 days. The regimen was well-tolerated by most patients. Hematologic toxicity was mild and did not recur following TMZ dose reduction.

Results: 36 patients (22 M, 14 F) received 141 cycles of therapy. Interim responses were evaluated after 2 cycles. In the 29 patients evaluable for response, 5/29 (17%) had a partial response (PR), 21/29 (72.5%) had stable disease (SD), and 3/29 (10.5%) had progressive disease, resulting in an overall response rate of 90% at 2 months. One patient had a CR after 7 cycles. One patient had a PR for 13 cycles but developed spinal cord tumor. Average duration of response was 5.2 months (range, 2-13). The 6-month PFS for 23 evaluable patients was 8/23(35%) and 6-month overall survival rate of 19/23(83%).

Conclusions: A regimen of twice-daily TMZ and celecoxib is a safe and potentially effective regimen for the treatment of recurrent high-grade glioma.
.................................

Excerpts on Avastin - this I believe is expensive
Posted on: 10/20/2005
Genentech in collaboration to explore Avastin for brain cancer treatment
10.20.2005, 02:29 AM

BURLINGAME, Calif (AFX) - Genentech Inc said it has entered into a collaboration with Accelerate Brain Cancer Cure (ABC 2), a non-profit foundation, to explore the potential of Avastin for treating patients with glioblastoma multiforme (GBM), an especially deadly form of brain cancer.

The collaboration is focused on a novel imaging study of patients with recurrent GBM who are enrolled in a Phase II clinical trial at Duke University. The two parties will initially share development expenses and if the results are successful, ABC (2) will provide access to its resources for a Genentech-sponsored randomized clinical trial in relapsed GBM.

'Encouraging preliminary data from early-stage research of Avastin in glioblastoma multiforme led us to initiate a Phase II study to gain further insight into Avastin's potential role in this setting,' said Gwen Fyfe, Genentech's vice president of Clinical Hematology/Oncology.

newsdesk@afxnews.com ak/
Further to it:
Avastin is a therapeutic antibody designed to inhibit Vascular Endothelial Growth Factor (VEGF), a protein that plays an important role in tumor angiogenesis and maintenance of existing tumor vessels. By binding to VEGF, Avastin is designed to interfere with the blood supply to tumors, a process that is critical to tumor growth and metastasis. It was the first U.S. Food and Drug Administration (FDA) approved therapy designed to inhibit angiogenesis and is approved for the first-line treatment of metastatic colorectal cancer in combination with intravenous 5-FU-based chemotherapy.
"We are very excited to support Genentech's efforts to study the potential of Avastin in patients with GBM," commented John Reher, ABC(2) Executive Director. "Our mission to accelerate a cure for brain cancer depends in large part on screening therapies that are already approved for other diseases, which if proved useful in brain cancer, can quickly be moved through clinical trials and to the patients who need them. The collaboration with Genentech to study Avastin in patients with brain cancer is precisely consistent with our mission."
"Encouraging preliminary data from early-stage research of Avastin in glioblastoma multiforme led us to initiate a Phase II study to gain further insight into Avastin's potential role in this setting," said Gwen Fyfe, M.D., Genentech's vice president of Clinical Hematology/Oncology. "We look forward to collaborating again with ABC(2) and the research centers in their network."


Hope this helps
Mike Gabriel


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 Post subject:
PostPosted: Fri Oct 28, 2005 9:58 am 
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Joined: Tue Jul 19, 2005 10:12 pm
Posts: 260
Location: Melbourne
Hi Chris,

There is a little research on most of these on Jane's site, on the main page there is also drug information for most that you mention: http://www.jane.symons.com.au/links1.htm

I will tell you here of Jane's experience with these, and prices based on Australian dollars (pacific pesos compared with the mighty British pound!).

Chris_Snaith wrote:
The drugs which seem to be the seem most promising are: Accutane Celebrex Chlorinique Tamoxifen Thalidomide


Accutane - Jane does 14 days on/14 days off at 160mg a day. The Cost is Aus$320 per month, side effects have been dry skin.

Celebrex - Jane has a high dose of 800mg a day. Haven't noticed side effects, could be related to the stroke Jane had. Covered here by the PBS (equivalent of the British NHS) if your doctor chooses to say that you have an illness such as arthritis.

Chlorinique - I wouldn't put this in this group of "most promising" but it has some efficacy. It is cheap and has few known side effects, Jane had no side effects when on it. (I assume you mean Chloroquine, the anit-malaria drug.)

Tamoxifen - There is some debate on this, recent trials showing efficacy are hard to find, yet it is widely used by the best brain tumour centres. Jane had 200mg a day, there were no noticeable side effects but could also be related to the stroke Jane had. It is covered by the PBS here, probably also by the NHS in the UK if your doctor is crafty.

Thalidomide - This has worked well for Jane at 150mg a day. It is hard to get and is expensive AUS$1425 per 28 days. Side effects are drowsiness (have it at the end of the day), neuropathy (take some supplements), and constipation.

Chris_Snaith wrote:
Others I’ve heard of but I’m not too familiar with include: Avastin Caelyx Cimetidine Clomipramine Glitazones Iressa, tarceva and erbitux STI-571 (Gleevec) Tarveca


Avastin - This is an anti-angiogenic product, it is the most promising thing in years, the results reported so far are just amazing. Jane is currently on fortnightly infusions of Avastin at 400mg. It is very expensive, AUS$2500 per fortnight, Jane has had no side effects so far.

Caelyx - This is chemo. Jane had this via infusion, it really knocks the white blood counts and for Jane caused general lethargy. It should be covered by the NHS. If you have a FISH test done on your tumour sample and it showed p53 issues, then Caelyx would be a good chemo choice.

Cimetidine - Helps stop the migration of cancer cells (metastases). Inexpensive old drug with few side effects (none for Jane)

Clomipramine - This is an anti-depressant, a trial is being run in the UK (you are in the right place for this one!). Jane tolerated it quite well but it made her blood pressure go too low, so we had to stop it (this is a rare occurrence). This is also an old drug, there are few side effects.

For Glitazones Iressa, tarceva and erbitux STI-571 (Gleevec), Jane has had none of these so I really can't comment from personal experience.

Cheers,

Ross.


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 Post subject:
PostPosted: Sun Oct 30, 2005 9:08 pm 
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Joined: Mon Sep 05, 2005 12:58 pm
Posts: 18
Location: Queensland Australia
Hi Chris,

I managed to get my hands on a copy of MIMS (Dr's reference guide to drugs) and it has been very helpful in decision making regarding which treatment path to follow. Its got lots of juicy info about side effects, interactions and contraindications. I'm not sure how available MIMS is though as my copy "fell off the back of a truck". The book does mention eMIMS, which I take to be somekind of web site or something. Maybe do a search and see what you come up with.

Hope you are doing well.

Jennifer


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 Post subject:
PostPosted: Sun Oct 30, 2005 10:47 pm 
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Joined: Tue Jul 19, 2005 10:12 pm
Posts: 260
Location: Melbourne
jennifer blacklock wrote:
The book does mention eMIMS, which I take to be somekind of web site or something. Maybe do a search and see what you come up with.


eMIMS is, as Jennifer suggests, an electronic version of MIMS publications. It is a really cool site but you need to have a subscription to the hardcopy to get an online account, and that requires a professional health worker registration and £149.00 per annum.

You can find the site at:

http://www.emims.net


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