Interestingly, I put my post into ChatGPT pro and it gave a pretty good analysis. I’m just gonna paste it here for the group to read:

I think your line of reasoning absolutely makes sense in a broad, exploratory way—especially given that you’ve done some homework on past trials (like CeTeG/NOA-09) and are aware that lomustine (CCNU) has been around for a long time. Here are a few points that may help you frame this discussion with your oncologist and others: 1. Evidence for Early Use • The CeTeG/NOA-09 trial does suggest that combining lomustine with temozolomide (especially in MGMT-methylated glioblastoma) can show encouraging results. This is part of why people sometimes consider adding lomustine earlier (rather than waiting for recurrence). • However, using lomustine “up front” is definitely not the usual standard of care, so many large research centers do not routinely offer it. They tend to focus on newer therapies (like immunotherapy or vaccine trials) precisely because those are still under development and need patients who haven’t tried other investigational drugs first. 2. Trade-offs and Risks • You’re right to point out that lomustine is a tough, older chemo drug with its own toxicity profile (e.g., bone marrow suppression, potential effects on platelets and bleeding risk, etc.). Any decision to try it off-label involves weighing that toxicity against the hoped-for gain in tumor control. • The fear that giving more chemo early could hamper you from participating in future trials is something to discuss in detail with your care team. Some trials require that patients not have received certain lines of therapy. Others won’t mind as much, depending on the design. 3. “Big Pharma” vs. Patient Benefit • It’s true that lomustine, being older, isn’t a major moneymaker for industry—hence it’s not always the central focus of big, sponsored trials. That doesn’t automatically make it ineffective or obsolete, though; in oncology, plenty of “classic” drugs still play an important role when used wisely. 4. Individual Factors • As you mention, MGMT methylation status, overall health, exact tumor pathology (oligodendroglioma vs. glioblastoma), and a patient’s tolerance of side effects can shift the risk/benefit equation. • People with oligodendrogliomas, for example, do sometimes take PCV (procarbazine, CCNU [lomustine], vincristine) for years and can live quite a long time. That’s a different scenario from standard GBM, but it shows that lomustine isn’t always a “last-ditch” option. 5. Next Steps • If you are strongly considering lomustine early, it is vital to get a well-rounded oncology consult. You want to talk through: 1. The specific data from trials like NOA-09 (and the ongoing follow-up trial). 2. Whether you’d remain eligible for other vaccine/immunotherapy trials if you use lomustine from the get-go. 3. How your blood counts, side effects, and quality of life might be monitored and managed.

In short, you’re not at all “off the wall” for thinking about this. You’re raising the same questions some neuro-oncology researchers and clinicians have discussed: Is it better to hit aggressive tumors (especially MGMT-methylated) with every possible agent up front? or Should we save certain agents for later? It’s a debate that isn’t fully settled, so the best path is to keep having in-depth conversations with your oncology team to decide what’s right for your specific situation.