Chemotherapy for Glioma

It is natural for patients and family members to have questions about how chemotherapy may change their lives. The good news is that doctors and scientists have a growing understanding of how to effectively use chemotherapy for gliomas, and how to reduce negative effects.

Physicians often use chemotherapy in conjunction with surgery and radiation to treat brain tumors. Chemotherapy attacks rapidly dividing cancer cells. However, chemotherapy also impacts other rapidly dividing normal cells in the body. 

This article discusses several aspects of chemotherapy for brain tumors and cancers and examines short and long-term side effects. 

Before chemotherapy, the patient journey begins by consulting different physicians. This journey often includes oncologists, neurologists, and neurosurgeons. These professionals will build a treatment plan based on the unique needs of each patient. This plan may include a combination of surgery, radiation, and chemotherapy. The decision to initiate chemotherapy may take place before or after surgery.

The process for receiving chemotherapy is relatively straight-forward. During chemotherapy, if medication is not available in pill form, nurses may need to obtain intravenous access (start an IV). If chemotherapy will be administered routinely and frequently, patients may have the option to receive a long-term port to avoid continued needle sticks. Chemotherapy often happens in phases; patients receive treatment and then take time to recover.

Temozolomide (Temador) and bevacizumab (Avastin) are two popular chemotherapeutics used to treat glioma. 

Here is more information on each medication: 

• Temozolomide works by inhibiting the growth of rapidly dividing cells. This medication binds to an area on the DNA of cancer cells, causing them to self-destruct. Some tumors, such as certain mutations in glioblastoma, may have mutations that make them more susceptible to temozolomide treatment. Of note, temozolomide is often taken by mouth, in pill form.
• Avastin stops blood vessels from growing. The idea is to prevent tumors from creating new blood supply, thereby cutting off the blood supply to a glioma and preventing them from growing or recurring. This medication is often administered through an IV, directly into the bloodstream.

Now we will discuss side effects.

The side effects of chemotherapy are sometimes directly related to the action of the drugs and sometimes the result of other treatments. Your oncologist and those administering the drugs are best suited to explain the potential side effects based on the dosage and type of chemotherapy you receive.

Here are several short-term side effects of two common types of chemotherapy used to treat gliomas: 

• Side effects for Temador (temozolomide): This medication will also affect other rapidly dividing cells in the body, leading to hair loss, intestinal irritation (causing nausea), stunted blood cell production, fatigue, and a weaker immune system (increased risk of infection).
• Side effects of Avastin (bevacizumab): Patients may see traditional side effects associated with other types of chemotherapy, as listed above, but there is also potential to see vascular (blood vessel) related side effects, including nose bleeds or skin rashes. There also may be increased risk of heart attack or stroke.

Now, let’s discuss the long-term side effects of chemotherapy.

Patients wonder how long it will take to heal after chemotherapy. How will life look once cancer treatment is over? 

Here are some common questions about long-term side effects of chemotherapy for glioma: 

• Will I have personality changes after chemotherapy? 
• Is there memory loss after chemotherapy? 
• How long can you live after brain tumor chemotherapy? 
• How long after chemotherapy can you drive? 
• What is the success rate of removing brain tumors with chemotherapy? 

Here are some answers.

Everybody will have a different experience after chemotherapy. It is difficult to predict the exact impact on personality. Some people do surprisingly well, and others are impacted more substantially as a result of chemotherapy and the tumor burden. Sometimes it is difficult to separate the side effects of chemotherapy from those of the tumor and the reaction of the patient due to the life altering diagnosis of a brain tumor.

Generally, during chemotherapy, you will be less energetic and less enthusiastic about rigorous activities. Some people may experience depression. However, many patients report that their symptoms from chemotherapy improve after treatments have finished.

Many people wonder about losing and regaining memory after chemotherapy. Chemotherapy can cause intermittent memory changes and difficulty concentrating. Some people call this "chemo brain" or cancer-related cognitive impairment (CRCI). 

Studies have shown that CRCI can result from the presence of a tumor in the body, even without treatment. However, this can become even more noticeable with the introduction of chemotherapy, coining the term “chemo brain”. CRCI can occur from the combined stress of chemotherapy, radiation therapy, and general mental and physical exhaustion. Not everyone experiences this condition, and every patient will be different. Will memory and concentration come back after chemotherapy treatment? Most often, in time, memory will improve.

Patients often avoid driving after their first couple of chemotherapy treatments. Then, based on how they have responded, they can make an informed decision on the safety of high-risk activities such as driving. 

There is no hard rule about when someone can drive after chemotherapy. However, it is important to consult with your physician and listen to your body when deciding about when it is safe to begin driving after chemotherapy. 

Chemotherapy for glioblastoma is usually combined with surgery and radiation. Chemotherapy often enhances these other treatment methods. The success of chemotherapy depends on the patient's age, the grade of the tumor, and the response to other treatments. 

Gliomas are graded by the World Health Organization (WHO) with grades ranging from I-IV. WHO Grade I gliomas have the best chance of long-term survival, while WHO Grade IV gliomas carry the lowest survival rate. How long can you live after receiving chemotherapy for a brain tumor? 

It is difficult to predict how long someone will live after treatment for gliomas. Survival rates hinge on multiple factors. Many patients with low-grade gliomas have over a 90% chance of 5-year survival. However, for high-grade gliomas, the 5-year survival rate is much lower, ranging from 6-9% in older adults to 22% for younger individuals. The number of factors that influence survival in these situations makes it difficult to quantify the precise benefit of chemotherapy in isolation.

Note: Consider survival rates within context. The 5-year survival rate is at least five years old and does not account for recent advances. Also, broad statistics do not account for the unique situations of each patient. 

• As a patient begins their chemotherapy journey, it is reassuring to know a little bit about what to expect.
• Receiving chemotherapy for gliomas is a new journey for many patients; however, preparing for obstacles and building a network of support will give patients hope and set them up for optimal outcomes.

• American Cancer Society
• American Society of Clinical Oncology
• Mayo Clinic