GBM, Boswellia, and a Retirement Party

The integrative approach in glioblastoma is not about replacing the Stupp protocol. It is about making Stupp work better, protecting neurological function, getting patients off steroids faster and giving the immune system something to work with.

Fred came to me a few weeks after a near-total resection of a left frontal glioblastoma, IDH-wildtype, WHO grade 4. The tumor sat directly at Broca's area and he had expressive aphasia. He was a health and fitness teacher. Words were his work. His MGMT promoter was hypermethylated at over 80%, the single most favorable prognostic marker in newly diagnosed GBM, and it shaped how aggressively I approached his integrative protocol.

Boswellia with AKBA was the intervention I was most confident in. It reduces cerebral edema, and several months in his imaging showed exactly that. Every milligram of dexamethasone he did not need was a win. Around it we built curcumin to sensitize the tumor to temozolomide, turkey tail for immune support during chemotherapy, a 1:1 THC:CBD tincture for quality of life, and a ketogenic diet with overnight fasting under an oncology dietitian. Later came low dose naltrexone, tadalafil and valganciclovir, each with its own rationale. Not all of it has RCT-level evidence in humans. I say that clearly to every patient.

Nothing went smoothly. It never does with GBM. But by one year he was down to 1.5 mg of dexamethasone from 10 mg, having what his wife called "really good weeks," and he went to his retirement party. Fred lived with GBM for two and a half years.

The other lesson is harder. When a prognosis is this heavy, the rest of the person quietly disappears from the conversation. No one had asked Fred and his wife about intimacy. The retirement party, the trip to Italy, the quiet question about intimacy, these are not detours from the clinical work. They are the clinical work.

If you or someone you love is newly diagnosed, ask this first: what is the MGMT methylation status, and what is the percentage?

Read the full case on Integrative Oncology Insights, including doses, references and the reasoning behind each intervention.

I see patients in Seattle, in person on Capitol Hill and by telehealth throughout Washington and Oregon. Book a free 15-minute consult.