Expert: Claes-Gustaf Nordquist, M.D. - 10/8/2009

Question
QUESTION: Hello Doctor, on may 3 of this year my wife a young 45 year old very active woman was diagnosed with a GBM grade 4. Two surgeries followed along with a 6 week course of radiation and oral Chemo (Temodar) along with an assortment of meds, Keppra, Decadron, Bactrim and Zofran. She is taking Avastin IV treatments every two weeks followed by Temodar IV treatments once a month. To date she has not had any seizures nor have I seen any lack of memory. If you didn't know what had happened in her life, you wouldn't suspect a thing. Weight gain and hair loss makes her feel uncomfortable so we tend to stay home. We are having a difficult time getting a realistic time line from our medical advisers. We'd appreciate your unbiased prognoses. Thank you. JJ

ANSWER: This will be difficult since your wife is receiving a new treatment for which we so far lack experience. This new tratment/medication is Avastin. It is therefore difficult or impossible for me to give you a sure evaluation. What I can tell you is the situation that existed before the introduction of Avastin into this kind of treatment. All grade 4 glioblastoma multiforme cases have up to that point in time proved to be hopeless. Treatment (surgery, radiation therapy & Temodar) did relieve symptoms temporarily and did prolong survival to some extent but no patient was ever cured and all cases proved to be fatal with a survival time (with full treatment) of around one year after primary treatment or somewhat longer. What effect Avastin will have I do not know - no one knows in fact. But hopefully it will at least extend the survival time to some extent. Though I do not know. Only time will tell. That is all I - or anybody else - can tell you at present.


---------- FOLLOW-UP ----------

QUESTION: Thank so much Doctor. I failed to mention that on a follow-up MRI a tumor on her left frontal lobe appeared which was thought to be there but until the recetion occurred it couldn't be confirmed. it is the size of a golf ball. that's when Avastin treatment was started. I know we need to have another MRI to see what's going on now after six Avastin treatments but can you tell me what to expect which will tell me time is running out. we would like to take a trip but are uncertain about medical help along way should it be required. I'm scared to death, but want to be a realest about this. thanks again for your time. jay

Answer
Right, one - or more - MRI brain scan(s) is/are necessary to make some sort of prediction of what is happening. Well if things develop in a bad way your wife will become more and more confused and sleep more and more. There may be stroke like symptoms and even epileptic fits. If/when she sleeps all the time her end will be near. She will then drift into a coma and then pass away. There will be little pain - if any. That is what I can tell you with regards to developments of this kind of tumors based on experiences at present.
I'm sorry I have nothing better to tell you!