Brain Tumors: Primary - Chemotherapy

Highlights	Diagnosis	Other Treatments
Introduction	Common Brain Tumors	Treatment for Complications
Symptoms	Treatment	Resources
Risk Factors	Surgery	References
Causes	Radiotherapy
Prognosis	Chemotherapy

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Chemotherapy

Chemotherapy involves the use ofdrugs to kill cancer cells. They may be given by mouth,injected into an IV, or injecteddirectly into the central nervous system. Chemotherapy is not an effective initial treatment for low-grade brain tumors, mostly because standard drugs cannot pass through the blood brain barrier. Of some promise, researchers have identified certain genetic arrangements in specific brain tumors that make them sensitive to the effects of chemotherapy. In general, however, chemotherapy is usually administered in brain cancer as salvage therapy for recurrent or slowly progressing cancers in patients who have previously been treated. The role of chemotherapy with brain cancers is constantly under investigation and there are some promising studies.

Drugs Used in Chemotherapy

Carmustine (also called BCNU). Carmustine is known as a nitrosourea. The response of gliomas to these agents appears to depend upon certain genetic factors. About 70% of gliomas have an enzyme (MGMT) that protects against their actions. The other 30% are sensitive to it. At this time, it is commonly used for glioblastoma multiforme and to date, no agent has proved to be superior for these tumors. Unfortunately, most patients quickly develop resistance to the drug, so there have been few improvements in survival rates with its use.

PCV and its Agents. The drug regimen called PCV (procarbazine, CCNU, and vincristine) is effective treatment for many common brain tumors. (CCNU is also referred to as lomustine and, like carmustine above, is a nitrosourea.) PCV has significant benefits for about two-thirds of patients with oligodendrogliomas. It has produced improvements in patients with anaplastic astrocytoma and glioblastoma multiforme, but to date does not appear to be any more effective than carmustine for these tumors. This regimen has significant toxicity, including suppression of red blood cell production and cause nausea, vomiting, and weight loss. Patients must adhere to certain dietary restrictions. Each of these drugs is also used separately and in other combinations.

Temozolomide (Temodar). Temozolomide, the first new drug approved for brain tumors in several decades, may improve quality of life and increase the time to progression for many patients with malignant gliomas. Temozolomide is taken by mouth and has relatively few side effects. In 1999, it was approved for adult patients with anaplastic astrocytoma that did not respond to other treatments. In 2005, it was approved for use during and after radiation therapy for patients newly diagnosed with glioblastoma multiforme. It is showing promise for recurrent high-grade gliomas, anaplastic oligodendrogliomas, and low-grade astrocytomas. It has only modest and short-lived effects on recurrent gliomas. Clinical trial results presented at the 2004 American Society of Clinical Oncology (ASCO) meeting confirm that temozolomide administered during and/or after radiation is a first-line treatment for glioblastoma multiforme. A 2005 study, published in the New England Journal of Medicine, reported that adults with newly diagnosed glioblastoma who received temozolomide during and after radiation therapy had a higher rate of 2-year survival than patients who received radiation alone.