A essay on IDH1 mutation or.. Tom’s draft treatment plan

We got the pathology report on Friday. It’s missing a few things that we should have in the next week or so but there was enough info to move forward and meet up with his oncologist earlier than planned, so we met with him today. It’s odd to pray for a genetic mutation, but we had been hoping that the sample would contain the IDH1 mutation that his prior tumor had which made it susceptible to chemo and thankfully it does have that again. It appears that it is very genetically similar to his last tumor. Therefore his oncologist has proposed the same treatment as before, radiation and chemo. He will also likely wear the Optune device again when he finishes radiation. He would also continue the chemo cycles he did before likely 9 mos to a year post radiation.

The chemo that Tom would take is Temodar, it comes in pill form and is shown to be effective used in conjunction with radiation and again the IDH1 mutation makes it more susceptible.

We also learned something new. They continually change the classifications of these tumors as they learn more about them and right now genetics drives the classifications. Because Tom has this IDH1 mutation, they now classify tumors with that mutation as astrocytoma grade 4. It’s still genetically the same tumor he had before, but a different name and also carries a higher median survival rate, moving from median 18 mos to 3 years. We all know Tom will be an outlier again and while it seems like we have a long road ahead, Tom is healthier than last time and doesn’t have the heavy surgery recovery and vertigo he had last time.

Finally, there is one additional drug that may be an option because of the IDH1 mutation. It has had good success and was just approved by the FDA for grade 1 and grade 2 tumors last month: vorasidenib.

We hope to get going with the chemo and radiation as soon as possible. Ideally we will meet with our new radiation oncologist next week, get their treatment plan (radiation would be either 3 or 6 weeks long) and get started.

This is still somewhat hard for both of us to reconcile as Tom is doing so well physically and has no symptoms. We are doing our best to keep him active at a heart rate of 120 or less until his surgeon clears him in 3 more weeks.

As always, thanks to all of you who have shown support and reached out.