Glioblastoma at the time of Covid-19

7 April 2020 0 By Roberto Pugliese

These days I have received some e-mails from people, patients or family members and friends of patients with glioblastoma, they are of course worried and this seminar I have just seen can be really helpful. It is a webinar of the Musella foundation with the neuro oncologist Eric Wong of the Center for Brain Tumors and of the Neuro Oncology Unit of Beth Israel Deaconess Medical Center and Harvard Medical School.

The webinar identifies some important things that brain tumor patients should know now that we are in full crisis for Covid-19.

For example, it is very important to know through a blood test the number of CD4 and CD8 glycoproteins because these are involved in the functioning of the immune system.

In fact, Decadron, Temozolomide and Lomustine significantly lower the number of CD4 and CD8 glycoproteins which make you more vulnerable to a Covid-19 infection.

The use of Temozolomide for patients with non-mitilated MGMT mutilation factor is controversial. Most neuro-oncologists use it and some prefer to use alternative treatments. The opinion of dr. Eric Wong is that the benefit / risk ratio in this case is not high enough especially given the Covid-19 pandemic and it would be better to try other treatment options.

The video is very interesting that taught me many things I did not know. In fact, chemotherapy is known to lower the effectiveness of the immune system. In general, if an effect of this kind is noticed, chemotherapy is stopped. With Covid-19 in circulation a different approach to the brain tumor patient is suggested which should be more proactive and less reactive. The video describes a certain similarity between virus immunity and cancer cell immunity.

For example, the presence of a high number of CD4 is known to be related to longer survival in patients with glioblastoma multiforme. It is also known that basically patients with glioblastoma even before starting treatment have a CD4 number lower than the average population. These patients are also typically more vulnerable to infections.

Glioblastoma patients also use Temozolomide, dexamethasone and lomustine. Dexamethasone is known to affect lymphocytes and monocytes and also that it adversely affects the survival of glioblastoma patients. Lomustine also lowers the number of lymphocytes. The combined use of Temozolomide and Lomustine increases the survival of patients with glioblastoma but lowers the immune system and creates other complications.

It all depends on the amount of virus you are exposed to. If you are young and strong, a moderate dose of virus does not create problems but if you are elderly, it could be lethal. In the case of over exposure to the virus as it happens to medical and nursing staff, even a strong immune system may not be enough. Deamethasone, temozolomide and lomustine create immunosuppression and therefore even if young and strong you may find yourself with an immune system similar to that of an elderly person.

Finally according to Dr. Eric Wong neither the Optune device nor the Avastin seems to have any negative effect on the immune system.