TREATMENT PLAN

We had a very good meeting with Dr. Winick yesterday afternoon, and Susan and I feel very encouraged about the treatment plan that has been selected.

Ashley will begin taking Decadron, a steroid, in order to provide her with some immediate relief from the symptoms she has been experiencing recently due to the recurrent tumors: nausea and vomiting, headaches, and unsteady balance.

Her chemotherapy will consist of two drugs: VP-16 and Thalidomide. These will both be administered in pill form at home.

After about six weeks of treatment, an MRI will be performed to see if the tumors are responding.

THE DRUGS

VP-16 is one of the chemo drugs that Ashley received during her first course of treatments following her initial medulloblastoma diagnosis back in 1997. It was administered intravenously then, it will be administered in pill form this time. The principal toxic effect of this drug is bone marrow suppression, resulting in low white blood cell counts. Other possible side effects include nausea and vomiting, hair loss, and loss of appetite.

Thalidomide was used outside the United States in the late 1950's and early 1960's as a sedative and an anti-nausea medicine. It was widely prescribed to pregnant women to help with morning sickness and lack of sleep. After a few years, it was withdrawn from the market because of a high incidence of birth defects in babies born to women who used the drug while pregnant. Many "thalidomide babies" were born without arms or legs, or with severe deformities of their limbs. The properties of the drug that caused these birth defects is actually the very thing that makes it a potentially useful drug for treating cancer.

The following is quoted from an article entitled "Thalidomide For Brain Tumors", written by Jon Glass, MD, of the NYU Medical Center in New York.

Observations that thalidomide is also an inhibitor of angiogenesis (prevents formation of new blood vessels in tumors) has prompted investigations of its use in the treatment of cancer. In order for a rapidly growing tumor to maintain its growth, a tumor "signals" already existing blood vessels to sprout new branches to feed it. Without a supply of oxygen and other nutrients, tumor growth would be impaired. As a tumor continues to grow, additional blood vessels would need to be formed to sustain new areas of tumor growth.

The reason thalidomide caused babies to be born without arms and legs, or with deformed arms and legs, is that it inhibited in the developing embryo the formation of new blood vessels at the peripheral extremities of the "limb buds". Without an adequate blood supply, the "limb buds" were not able to grow into full limbs (arms and legs).

The reason thalidomide holds such promise in treating cancerous tumors is that it inhibits the formation of new blood vessels around the tumor. Without the formation of new blood vessels, the tumor cannot grow.

The most common side effect of thalidomide is sleepiness, so the pill is taken just before bedtime. Other possible side effects include the development of a rash, peripheral neuropathy (numbness in the fingers and toes), and constipation.