Chemotherapy and Supportive Care Medicines for Brain Tumors in Adults

Chemotherapy (chemo) is a treatment that uses medicines to destroy cancer cells. For brain tumors, chemo is most often used along with other treatments such as surgery and/or radiation therapy. Chemo can also be used by itself, especially for more advanced tumors or for tumors that have come back after other types of treatment.

Other types of medicines, such as corticosteroids, anti-seizure drugs, and hormones, can be used as supportive care to help prevent or relieve symptoms from brain or spinal cord tumors.

Which types of brain tumors are treated with chemo?

In general, chemo is used for faster-growing brain tumors. Some types of brain tumors, such as medulloblastomas and primary CNS lymphomas, tend to respond better to chemo than others. Chemo is not as helpful for treating some other types of tumors, such as spinal cord tumors, so it is used less often for these tumors.

Chemo drugs used to treat brain and spinal cord tumors

Some of the chemo drugs used to treat brain and spinal cord tumors include (in alphabetical order):

• Carboplatin
• Carmustine (BCNU)
• Cisplatin
• Cyclophosphamide
• Etoposide
• Irinotecan
• Lomustine (CCNU)
• Methotrexate
• Procarbazine
• Temozolomide
• Vincristine

These drugs can be used alone (such as temozolomide) or in combination (such as the PCV regimen: procarbazine, lomustine [CCNU], and vincristine), depending on the type of brain tumor.

How is chemo given for brain tumors?

Chemo is given in cycles, with each period of treatment followed by a rest period to give the body time to recover. The cycle length and schedule depend on the drug and the treatment plan.

For most brain tumors, chemo is given into a vein (IV) or taken by mouth as a pill. These drugs enter the bloodstream and reach almost all areas of the body.

Other ways chemo might be given

Because the brain has a protective barrier (the blood–brain barrier), some drugs don’t reach high levels in the brain, so sometimes chemo is given in other ways.

An Ommaya reservoir or ventricular access catheter might be placed in a ventricle of the brain during surgery to allow chemo to be given directly into the cerebrospinal fluid (CSF, the fluid that bathes the brain and spinal cord).

A lumbar puncture (spinal tap) might be used to give chemo into the CSF, especially if only one or a few treatments are needed.

Carmustine (Gliadel) wafers are dissolvable discs containing the chemo drug carmustine (BCNU). After removing as much of the brain tumor as is safe during a craniotomy, the surgeon can place the wafers directly in the area where tumor cells may still be. Because the medicine is released right at the tumor site, it causes fewer side effects in the rest of the body. Still, it can sometimes cause problems such as swelling in the brain or infection. Because of this, and since the benefits seem to be limited, many surgeons are cautious about using it.

Possible side effects of chemotherapy

Chemo drugs can cause side effects. These depend on the type and dose of drugs, and how long treatment lasts. Common side effects can include:

• Mouth sores
• Loss of appetite
• Nausea and vomiting
• Diarrhea
• Hair loss
• Increased chance of infections (from having too few white blood cells)
• Easy bruising or bleeding (from having too few blood platelets)
• Fatigue (from having too few red blood cells, changes in metabolism, or other factors)

Some of the most effective drugs against brain tumors tend to have fewer of these side effects than other common chemo drugs. Most side effects tend to go away after treatment. There are often ways to lessen these side effects. For example, drugs can often help prevent or reduce nausea and vomiting.

Some chemo drugs can also cause other, less common side effects. For example, cisplatin and carboplatin can cause kidney damage and hearing loss. Your doctor will check your kidney function and hearing if you are getting these drugs. Some of these side effects might last after treatment is stopped.

Be sure to report any side effects to your cancer care team while getting chemo so you can be treated promptly. Sometimes, the doses of the drugs may need to be reduced, or treatment may need to be delayed or stopped, to prevent the effects from getting worse.

Supportive care drugs for adult brain tumors

Supportive care drugs do not treat brain or spinal cord tumors directly, but they may help lessen symptoms caused by the tumor or its treatment. These drugs are often an important part of treating brain tumors, regardless of what other treatments a person is getting.

Corticosteroids (steroids)

Corticosteroid drugs such as dexamethasone (Decadron) are often given to reduce swelling around brain tumors. This may help relieve headaches and other symptoms.

Anti-seizure drugs (anticonvulsants)

Drugs may be given to lower the chance of seizures in people with brain tumors. Different anti-seizure drugs can be used. Because many of these drugs can affect how other drugs such as chemotherapy work in the body, they are not usually given unless the tumor has caused seizures.

Hormones

The pituitary gland helps control the levels of many different hormones in the body. If the pituitary is damaged by the tumor itself or by treatments (such as surgery or radiation therapy), you may need to take pituitary hormones or other hormones to replace the ones your body is no longer making.