Dr. Rajesh Gulati
Family Physician
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
My wife underwent brain tumor surgery seven months ago. She was diagnosed with oligodendroglioma grade 2, IDH-Mutant, 1p-19q codeleted. She completed radiation treatment four months ago for 30 days, alongside taking tablet temozolomide. Currently, she is undergoing PCV chemotherapy, which started two and a half months ago. She has just completed her first cycle. This chemotherapy regimen appears to be challenging. Can you please provide advice regarding the effectiveness of Temozolomide chemotherapy in her case? I have attached her pathology report here. Kindly provide your suggestion.
Hello,
Welcome to icliniq.com.
I read your query and understood your concern. Firstly, I would like to inform you that Temozolomide is effective in IDH-Mutant, 1p-19q codeleted tumors. I have reviewed the reports you attached (attachments removed to protect the patient’s identity). It is advisable to repeat the scan after three months to assess the treatment response. If PCV ( Procarbazine, Lomustine, and Vincristine ) chemotherapy proves to be very challenging, it may be necessary to consider reducing the dosage. I hope this has helped you. Kindly follow up if you have more doubts.
Thank you.
Patient's Query
Thank you for the reply doctor.
She took Temozolomide for 36 days during radiation therapy four months ago. Initially, it was supposed to be taken for 42 days, but the doctor advised stopping due to low platelet count. Following this, she started PCV chemotherapy two and a half months ago and completed her first cycle ten days ago. During this cycle, her platelet and neutrophil counts dropped significantly, causing the cycle to take two months to complete. She is set to begin the second cycle this week. The doctor suggested six cycles of PCV chemotherapy, each lasting 42 days. However, the first cycle extended to 60 days due to low blood counts. Considering her tolerance issues with PCV, is it advisable to switch from PCV to Temozolomide at this point? Kindly provide your insight.
Hello,
Welcome back to icliniq.com.
I read your query and understood your concern. I suggest reducing the PCV dosage by 50 %. PCV remains a viable option. If she is unable to tolerate even a 50 % dose reduction, then switching to Temozolomide is suggested. I hope this has helped you. Kindly follow up if you have more doubts.
Thank you.
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