Chemotherapy remains one of the most important treatments for cancer, including brain cancer. Many patients are prescribed this type of treatment by their doctors. Patients and their loved ones have a lot of questions: about the drugs, their effectiveness, the side effects, etc. We will answer some of them in this article.
How is chemotherapy used in the treatment of brain cancer?
Chemotherapy is a group of drugs that have a strong destructive effect on fast-growing cells, which include cancer cells. They are often used for oncological treatment, including for some brain tumours. The drugs are administered over several courses, sometimes intermittently, to give the body time to recover. Chemotherapy has a nonspecific effect – healthy cells of the body often get under the ‘friendly fire’. This manifests itself in the form of numerous side effects. Therefore, choosing the right course of treatment for brain cancer is a delicate task that requires a thoughtful balance between potential risks and benefits.
When diagnosed with brain cancer, chemo is rarely used as the primary and only treatment. Much more often, chemotherapy is given in combination with surgery or radiotherapy – before the surgery to prepare and shrink the tumour; or after removal of the brain tumour – to destroy residual cancer cells.
The use of chemotherapy in the treatment of brain cancer is complicated by the structure of this organ. Its vessels have a physiological feature called the blood-brain barrier (BBB). It protects delicate neurons from bacteria and viruses in the body, essentially isolating the blood that feeds the brain from the rest of the body. The capacity of the BBB is very low, and because of this, many powerful chemotherapy drugs do not reach the tumours growing in the brain. Because of this, chemotherapy for brain cancer is less effective compared to other cancers. Still, this doesn’t mean you should give up – for any diagnosis, there are treatment options that can save the patient. It’s worth consulting an experienced oncologist who can advise you on what progressive cancer-fighting methods are available for your diagnosis.
In general, chemotherapy works more effectively against fast-growing tumours than slow-growing tumours or, for example, spinal cord tumours. Treatment protocols reflect this accordingly. These are medical guidelines based on rigorous clinical research. They tell doctors which drugs have a proven efficacy for specific diagnoses in different patient groups. Treatment plans are drawn up on their basis, and foreign medical centres benefit from multidisciplinary oncology boards. This means that treatment for each patient is selected by a team of specialists, each of whom is an expert in his or her narrow field – for example, an oncologist, a neurosurgeon and a radiologist.
An incomplete list of brain tumours that can be treated with chemotherapy:
anaplastic astrocytoma or oligoastrocytoma;
In addition, chemotherapy can be used to treat cancer that has metastasised to another part of the body. Breast cancer, lung cancer and melanoma most often metastasise to the brain.
Treatment of brain cancer abroad has one significant advantage: the possibility of individual selection of drugs based on genetic analysis of tumour cells. Such a procedure is carried out in advanced foreign oncology centres. Doctors in laboratories can conduct tests that detect specific mutations in cancer cells. With this information, the oncologist can more accurately select drugs that will target these ‘weak points’ of the neoplasm.
Chemotherapy for brain metastases
Cancer metastases are formed when cancer cells detach from the primary site of the disease and travel through the blood or lymphatic pathways to a distant part of the body, where they take root and form new tumours. Therefore, the drugs that help with the primary tumour will be more effective with the metastases.
To date, chemotherapy has taken a back seat to the treatment of brain metastases. In the later stages, oncology usually reaches a very aggressive course and causes problems for the patient. In modern cancer centres, targeted therapy, immunotherapy and stereotactic radiosurgery play a much greater role in this group of patients. At the same time, the ASCO-SNO-ASTRO guidelines allow the use of chemotherapy in combination with other methods in the treatment of some cases of metastatic breast cancer.
Metastatic brain tumours are five times more common than primary tumours.
Metastatic brain tumours are characterised by rapid spontaneous growth. Quite often doctors see a characteristic picture of a close cluster of several small neoplasms on an image, which is common for this diagnosis.
The risk of developing brain metastases is quite high, especially in patients over 65 years of age. They form in approximately ⅓ of patients with stage 4 cancer. Because of the difficulties in treating these tumours, prevention is considered the preferred approach in oncology. By detecting cancer and starting treatment early, it is possible to avoid its metastasis altogether. The most effective solution to this problem is regular check-ups. Foreign clinics offer individually tailored check-up packages that combine several procedures that can detect various cancers at stage 1, and sometimes even at stage 0. These include for example, tests for oncomarkers and various types of imaging procedures – MRI, CT, PET-CT, etc.
The procedure: how to prepare and what to expect
Before starting chemotherapy, patients are routinely given a package of blood tests as standard. This is to make sure it is safe to carry out the treatment. These tests will be repeated before each new cycle of chemo, of which there are on average 4-8, but there can be significant variations.
A severe drop in blood counts tells doctors that the chemo is beginning to deplete the body. In such cases, the course is suspended, and the patient is given time to recover.
Usually, if patients are treated abroad, chemotherapy will be carried out on an outpatient basis. Such polyclinics have special wards where patients are treated in comfortable cubicles under the supervision of nurses. Depending on the patient’s condition and the planned treatment, they can stay in the hospital, or near the clinic in a hotel/rental flat, coming to the medical centre daily for treatment.
There are several methods of chemotherapy for brain tumours. In most cases, intravenous drips are used, but some drugs are available in tablet or capsule form. Special forms of chemotherapy are intracranial and intravertebral for brain and spinal cord tumours respectively.
Intracranial chemotherapy for brain cancer
This procedure is done to deliver drugs closer to the tumour, which has two important effects. Firstly, chemotherapy becomes more effective. And secondly, chemo has less contact with other organs, which means that the patient experiences fewer side effects. However, intracranial chemo is rarely used, for example, in the treatment of glioblastoma multiforme.
There are two methods of delivering chemotherapy directly to the brain in cancer: wafers and Ommaya reservoir.
Chemotherapy wafers are coin-sized gel implants that are placed directly on the area where the brain tumour was located after the brain tumour has been removed. Within 2-3 weeks they dissolve, continuously releasing a drug that prevents the growth of the neoplasm.
The Ommaya reservoir is a small device consisting of a catheter connected to the ventricle of the brain and a plastic reservoir attached to it. With their help, the doctor will be able to inject medication directly into the brain. Installation of an Ommaya reservoir also requires surgery.
Last but not least, patients worry about the side effects of chemotherapy. Unfortunately, they can neither be predicted nor avoided. The body’s reaction to drugs is highly individualised. However, in advanced foreign oncology centres, great care is taken to maintain patients’ well-being during treatment. Many of the effects of chemo can be controlled, and in other cases, the oncologist will adjust the drug and its dosage, or prescribe a break in the course.
Here are some of the most common side effects of chemotherapy for brain cancer:
Fatigue, lethargy;
Falling levels of immune cells in the blood, leading to vulnerability to infections;
Tendency to bleeding and bruising;
Loss of appetite, weight loss, nausea, vomiting;
Mouth ulcers;
Diarrhoea and constipation;
Hair loss;
Pain.
Most of these conditions resolve some time after the treatment ends. In the meantime, it is possible to help most with concurrent therapy to minimise discomfort and complications.
Dr Lisa De Angelis, Chief Medical Officer at Sloan-Kettering Medical Center, says:‘I have been treating glioblastomas for more than 30 years, and in that time I have been able to see significant progress in the quality of life of patients with this diagnosis. Today, we are seeing something that was never seen before – patients who six or seven years after treatment are leading remarkable, completely normal and fulfilling lives. Newer drugs that don’t cause as many side effects as before have played a big part in this.’.
Some drugs can also adversely affect fertility. For this reason, most young people facing cancer treatment are offered egg/sperm freezing to keep an option to have IVF in the future.
What can be done to improve the effectiveness of chemotherapy treatment for brain cancer?
Chemotherapy is not the only weapon against brain cancer available to modern medicine. Radiation therapy and surgery play a major role in achieving durable remission. However, a large number of innovative methods and drugs are now available that can dramatically improve the prognosis of brain tumours when combined with chemotherapy. Solutions can be found even for particularly aggressive, malignant tumours that continue to grow despite treatment or return after treatment.
Brain cancer treatment is much more effective if several methods are used simultaneously – chemotherapy, immunotherapy, radiation therapy, monoclonal antibodies, etc. When combined, they enhance each other’s effectiveness, making the therapeutic effect better than just the sum of the drugs’ strengths alone.
Northwestern Medicine has recently shared the success of a new device that has the potential to revolutionise the use of chemotherapy for brain cancer. It is an implantable device that uses ultrasound to temporarily weaken the BBB, a major cause of chemo’s ineffectiveness in brain tumours. The device is still in the development stage.
Angiogenesis inhibitors | These drugs target the blood vessels close to and feeding the tumour. Without access to basic nutrients, they cannot continue to grow and spread throughout the brain. |
Growth factor inhibitors | This group of drugs has subtle effects on the tumour microenvironment. They disrupt the interaction between chemical signals (such as epidermal growth factor, common in brain tumours) and the relevant receptors. This interferes with the internal processes of the cancer cells. |
Targeting antibodies | These can ‘recognise’ cancer cells based on specific proteins on their surface caused by mutations. Before prescribing this treatment, immunohistochemistry of biopsy analyses is always performed to know which drugs will be effective. |
Monoclonal antibodies | These are drugs made from human immune cells. They can recognise the tumour. Once attached to the antigen on the cancer cell, they begin to signal the immune system of the presence of the pathogenic agent and attract other immune system cells to eliminate the problem. |
Dendritic cell therapy | Dendritic cells train the immune system to recognise and kill tumour cells. In particular, one study published in 2024 Nature Communications showed that when combined with immune boosters, dendritic cells can effectively fight even grade 3-4 malignant gliomas. |
Immunomodulators | Immunomodulators are a group of drugs that mainly aim to change the interaction between the immune system and the tumour. They can affect it in different ways, reducing the levels of some proteins and increasing the levels of others. |
Where to go for help?
We recommend you go to multidisciplinary or highly specialised medical centres with strong technological facilities. The experience of the oncologist and the availability of modern cancer treatment options play a major role, so these factors should also be considered when choosing a clinic. Our coordinating physicians can provide you with personalised recommendations based on the specifics of your case, free of charge. The most popular among our patients are:
Summary
One of the treatment options for brain cancer is chemotherapy. This method is rarely used alone, and most often goes in addition to surgery, radiation therapy, or stereotactic radiosurgery.
Chemotherapy may be used for malignant brain tumours, such as glioblastoma, before surgery or after the tumour has been removed, and for metastases to the brain.
The average number of chemotherapy courses prescribed for brain cancer is 4-8, but the number can vary considerably depending on the severity of the disease and the patient’s/patient’s tolerance to the drug.
Chemotherapy for brain cancer is most commonly administered in the form of intravenous drips, but there are also options for taking tablets or implantable drug wafers/reservoirs.
The effectiveness of chemotherapy can be improved by combining it with immunotherapy or targeted therapy. Drugs such as monoclonal antibodies and dendritic cells are used for brain cancer diagnoses.
Stay with MediGlobus and keep up to date with the latest news on the latest developments in foreign medicine. If you need help from a oncologist abroad – leave an appointment. Our coordinators will help you find a clinic that offers a treatment program that will help you.
Sources:
- 1. Cancer Research UK
- 2. Brain Tumor Research
- 3. American Society of Oncology
- 4. National Brain Tumour Society
- 5. Journal of Clinical Oncology – An American Society of Clinical Oncology Journal: Treatment of Brain Metastases
- 6. Treatment for Brain Metastases: ASCO-SNO-ASTRO Guideline
- 7. Northwestern University: Powerful chemotherapy drug reaches brain tumors using novel ultrasound technology
- 8. What Really Matters in Treating Brain Cancer: An Interview with Two MSK Experts