The Case of the Mutant Meningioma
Hello! Since it's been a while and I had an appointment with my neurosurgeon this week, I figured it's time for an update.
Recovery Recap
Overall, recovery from surgery continues and I am feeling more and more like myself. Better in some ways. I am so thankful that the headaches I experienced before surgery are resolved, allowing me to live my life again. Avoiding laughing because you are afraid your head will feel like it's splitting in half is not a way to live!
Unfortunately, there no improvements in my double vision. My day to day activities are getting easier as I adapt to the change. I tried a prism patch on my glasses but it only helped turn my double vision into single vision if I had my eyes focused just right. In someways it even distorted my vision more. To cope, I now use translucent tape over my right glasses lens allowing my right eye to retain some of its peripheral vision while blurring my vision enough that I effectively only see out of my left eye. Since, I'm 10 weeks out from surgery with no change in the eye movement, Dr. Almefty offered to refer me to an eye surgeon for evaluation for possible correction.
With Steve back to work, Finnley has now taken over the lead role in my physical rehabilitation. We are usually out on 2-3 walks per day. He also increases the challenge of my balance exercises by booping me with his snout when I am trying to stand on one foot! No, he has not managed to knock me over despite his best efforts... a testament to the success of my physical therapy.
Rachel, why the dramatic title?
So, you may be asking yourself, why did she call this post "The Case of the Mutant Meningioma"? Well. Because it turns out my meningioma is a mutant! It has a PIK3CA mutation to be exact. Perfect timing as we enter spooky season. But don't worry! Its more just a point of interest than anything to be concerned about.
I mentioned previously that after surgery, my tumor was biopsied, examined under the microscope and classified as a WHO Grade 1 meningioma. I also requested the specimen be genetically tested. This testing is not standard protocol for meningiomas though emerging research is finding it may be very important for improved grading accuracy and for possible new treatment options which is why I requested it.
Fortunately, a PIK3CA mutation does not appear to correlate with any aggressive tumor behavior, meaning its presence will probably not influence the growth of the remaining portions of my meningioma. Some mutations have been associated with such. In fact, some meningiomas that appear as lower grade meningiomas under the microscope will actually behave like higher grade meningiomas when they present with certain genetic mutations.
As time goes on and scientific research advances, the grading schema for meningiomas will likely include more genetic biomarkers, reflecting how genetic makeup and physical appearance under a microscope combined influence tumor behavior and aggressiveness.
The PIK3CA gene mutation is often present in cancers including colon, breast, endometrial, skin, ovarian, gastric, lung, thyroid, head and neck, pancreatic, esophageal, liver/biliary tract, as well as other tumor types (1). Certain chemo therapy drugs can directly treat tumors with these mutations. For example, Inavolisib and Alpelisib are both chemotherapy drugs on the market that target breast cancers with the PIK3CA mutation. Currently, no chemotherapy drugs exist to treat meningiomas, though there are research studies and clinical trials on the horizon to do so. In skull base meningiomas this is very promising research. Almost all of us in the skull base meningioma camp will have some residual tumor left after resection with the only options currently being additional surgery or radiation should the residual tumor grow. Hopefully someday, using genetic research, another option will be developed- chemotherapy drugs specifically targeted towards meningiomas and their unique genetic make up.
For now, we watch and wait. I am 10 weeks out from surgery and will soon (three months out) get my next MRI that will be compared to my post-surgical MRI and determine if Monica and Phoebe are behaving or partying too hard. For now, these will recur every 6 months. Hopefully they never grow but if not, hopefully some of the research will be translated into promising treatments allowing me to avoid both going under the knife or radiation.
Isn't science cool?
Reference:
(1) Samuels Y, Waldman T. Oncogenic mutations of PIK3CA in human cancers. Curr Top Microbiol Immunol. 2010;347:21-41. doi: 10.1007/82_2010_68. PMID: 20535651; PMCID: PMC3164550.
