Exploring Chemotherapy Options and New Therapies For Glioma
- Treatment for glioma typically involves a combination of surgery, radiation therapy, and chemotherapy — but the treatment path and combination can vary depending on several factors.
- New therapies, including targeted drugs and immunotherapy, are expanding treatment options for gliomas as well.
- In the context of glioma treatment, particularly for higher-grade tumors, the most commonly used chemotherapy drug is temozolomide (TMZ), but there are other options — including a combination approach known as procarbazine, lomustine, and vincristine or the PCV regimen.
- For patients who have something known as an IDH1 or IDH2 mutation, promising new drugs called IDH inhibitors may be an option.
Treatment is “individualized to the diagnosis and the grade of the tumor — often using advanced testing and next-generation sequencing to help determine if more standard radiation and chemo is the first option, or more targeted therapy,” Dr. Howard Colman, a neuro-oncologist at the Huntsman Cancer Institute at the University of Utah, tells SurvivorNet.
Chemotherapy for Glioma
Read MoreChemotherapy options for glioma include:
- Temozolomide (TMZ): Often used after surgery and radiation, TMZ is an oral chemotherapy that crosses the blood-brain barrier (a natural anatomic barrier that protects the brain), making it effective against gliomas.
- Lomustine (CCNU): This is sometimes used alone or in combination with other drugs for recurrent gliomas.
- Procarbazine, Lomustine, and Vincristine (PCV regimen): This combination is typically used in oligodendrogliomas with the 1p/19q co-deletion, which predicts better responses to this regimen.
Emerging and Promising Therapies
Advancements in glioma treatment have led to the development of targeted therapies and immunotherapies aimed at improving survival and reducing side effects.
Targeted therapies focus on specific mutations in tumor cells. If your glioma has certain genetic changes, targeted drugs may be an option.
“For certain tumors that have certain mutations at the DNA level or alterations at the DNA level, there are targeted therapies — and this is a relatively new development in brain tumors,” Dr. Colman explains. “We didn’t have those five years ago. So, depending on the type and grade of the tumor, if it has one of those targeted alterations, then sometimes the primary treatment will be that targeted therapy.”
Target therapy options include:
- IDH Inhibitors: For gliomas with IDH1 or IDH2 mutations, these drugs aim to slow tumor growth by interfering with abnormal metabolic pathways.
- BRAF Inhibitors: These can be used in rare gliomas with BRAF V600E mutations.
- EGFR Inhibitors: These are being investigated for glioblastomas with EGFR alterations.
Immunotherapy
Immunotherapy is a growing and potent arsenal against cancer. It has been designed to help the body’s immune system fight cancerous cells.
Though still under research, some promising approaches include checkpoint Inhibitors. In this class of drugs, the current drugs being studied are: Nivolumab, Bevacizumab, Pembrolizumab, Ipilimumab, and Durvalumab.
These drugs are thought to promote immune-mediated tumor destruction.
Tumor Treating Fields (TTFields)
Another exciting option in the brain tumor space is tumor treating fields (TTFs), a non-invasive therapy that uses low-intensity electrical fields to disrupt cancer cell division. It is FDA-approved for glioblastoma and used alongside chemotherapy.
Tumor treating fields use cutting-edge technology to target glioblastoma cells while sparing healthy tissue. This therapy involves placing an array of transducers on the scalp, which emit non-ionizing electromagnetic waves at a specific frequency. These waves disrupt the division of cancer cells, slowing or even stopping tumor growth.
Unlike traditional cancer treatments, such as chemotherapy and radiation, which often affect the entire body, tumor treating fields are a localized therapy. This means they focus on the tumor without causing significant damage to surrounding healthy tissues.
It’s recommended that the device that delivers TTFs be worn every day for most of the day.
Clinical Trials: Access to Cutting-Edge Treatments
Clinical trials offer patients access to novel therapies before they become widely available. For some patients with glioma, enrolling in a clinical trial may be the best option.
If standard treatments are not effective, discussing clinical trial options with your doctor may be beneficial.
Questions to Ask Your Doctor
- Have I been tested for genetic mutations?
- Am I a candidate for targeted therapy?
- What are the risks vs. benefits of the different approaches to chemotherapy?
- Are there any clinical trials I should consider?
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