Brain Tumors: Primary - Chemotherapy

Other Chemotherapy Agents Used or Investigated for Recurring or High-Grade Cancers

A number of drugs and treatments are being tested or used for primary and recurring tumors.

Tamoxifen, a breast-cancer drug, may also be beneficial in a minority of patients with glioma when administered continuously at high doses. More research is needed to determine which patients may benefit.
High-dose thiotepa along with bone marrow or stem cell transplantation is being tested for newly diagnosed aggressive oligodendroglioma as an alternative to radiotherapy. Although some patients have prolonged disease-free survival time, thiotepa has very toxic side effects, including encephalopathy (brain damage), liver damage, severe weight loss, and a drop in blood platelet count. High-dose thiotepa along with bone marrow or stem cell transplantation is being investigated for recurrent aggressive oligodendroglioma.
Paclitaxel (Taxol), a drug used for breast cancer, is also being investigated for gliomas. It is showing promise for patients with recurrent gliomas. In one study, paclitaxel with stereotactic radiosurgery improved results for patients with glioblastoma multiforme.
Topo I inhibitors block topoisomerase I, an enzyme involved in cell replication. Clinical studies have shown that the Topo I inhibitors topotecan and irinotecan injure brain tumor cells. Combinations of Topo I inhibitors with standard chemotherapy drugs, such as BCNU, is proving to be effective for some patients. Some studies suggest it may help some children with gliomas. They may also be important agents in radiochemotherapy. Less positive studies on irinotecan report that combinations with anti-seizure medications reduce its effectiveness.
5-fluorouracil (5-FU) is a standard chemotherapy agent for a number of malignancies. It has not, to date, been useful for brain tumors, because like most of these agents, it cannot pass the blood brain barrier. A new form (Ethypharm), however, employs a microsphere containing the drug that is implanted in the tissue. Early studies are promising. Investigators are also looking at genetic therapies to deliver the drug directly to the tumor.
Carboplatin with or without vincristine is being studied for low-grade progressive gliomas, which are difficult to treat with surgery or radiation.

Side Effects of Chemotherapy

Because chemotherapeutic drugs may also affect normal cells, side effects are common. To help offset these effects, chemotherapy is given intermittently over a scheduled period that allows normal cells to recover between treatments. Side effects include nausea, vomiting, fatigue, infection, bleeding, and hair loss. In addition, the agents used to treat symptoms (anti-seizure drugs, antidepressants, and corticosteroids) may interfere with standard chemotherapeutic agents. Specific drugs may have different complications; for example, vincristine can cause nerve injury and cisplatin may result in hearing loss. Procarbazine requires dietary restrictions. Side effects are almost always temporary and may be managed with other medications.