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  • Other Treatments for Brain Tumors

    Although surgery is usually the first and most definitive choice for the treatment of brain tumors , there are many instances where the brain tumor is considered inoperable, or where surgery cannot completely remove all of the tumor.
    When surgery is not a choice, or when surgery leaves residual tumor behind, other treatment options must be considered. Chemotherapy and radiation may be used to shrink (and potentially cure the individual of) the tumor mass. Or, these treatments may be used as “palliative treatment” to prolong survival and decrease the severity of symptoms caused by the brain tumor.
    Other treatments may also be used for brain tumors. These are often chosen based on the type of brain tumor present. They may be used alone or in combination with “traditional” chemotherapy and/or radiation.
    These other types of treatment include:
    • Targeted therapy
    • Immunotherapy
    • Phototherapy

    Targeted Therapy

    Targeted therapy harnesses a wide variety of different biological pathways to interfere with the ability of cancer cells to grow, divide, and/or spread. The drugs work on specific parts of the pathways for their effects. There are a number of different agents being investigated alone or in combination with other targeted therapies or with conventional chemotherapy or radiation.
    Examples of these types of treatments include:
    • Enzyme inhibitors—interfere with the cancer cells’ ability to grow and divide
    • Apoptosis inducers—target cancer cell to cause their death
    • Angiogenesis inhibitors—interfere with the cancer cells’ ability to create new blood vessels, which they need in order to continue growing
      • There are a number of anti-angiogenic agents being used. They include antibodies against the factors secreted by cells to promote new blood vessel growth (eg, bevacizumab [Avastin]), as well as various investigational agents.

    Immunotherapy

    Immunotherapies are treatments that improve the cancer-fighting ability of the person's own immune system or administer immune cells in order to fight cancer. These treatments include:
    • Monoclonal antibodies—Large quantities of lab-produced antibodies are given to the patient. These antibodies interfere with basic cell processes, thus stopping the cancer cell’s from growing, dividing, and interacting with other cancer cells. The antibodies' role is limited by their ability to cross the blood-brain barrier or blood-tumor barrier.
    • Cancer vaccines—Pieces of cancer cells or proteins modeled from cancer cells are given to the patient. This is done to activate the patient’s immune system to recognize and attack cancer cells.
    • Gene therapy—Gene therapy may attempt to alter the patient’s own genes in order to make them more successful at battling cancer cells. Or, this form of therapy may alter the cancer cells' genes in order to make the cancer more vulnerable to destruction by other forms of treatment.
    • Cytokines—These immune system substances may boost the effectiveness of other types of treatments, decrease treatment side effects, and improve the immune system’s ability to fight against cancer.

    Photodynamic Therapy

    This form of treatment uses light to activate special drugs. For example, a drug (called a photosensitizing agent) is given to the patient via a needle inserted into the arm. Over time, the drug accumulates in the specific area requiring treatment. The area is then exposed to light, which causes the drug to react with oxygen. This reaction creates a chemical that is toxic to the cancer cells, destroying nearby blood vessels required for growth by the tumor, and/or enhancing the immune system's ability to fight the cancer cells.

    References

    Lukas RV, Boire A, Nicholas MK. Targeted therapy in the treatment of malignant gliomas. OncoTargets and Therapy. 2009;2:1-19.

    Treatment information. National Brain Tumor Society website. Available at: http://www.braintumor.org/TreatmentInformation/ . Accessed August 18, 2009.

    Treatment therapy research. Childhood Brain Tumor Foundation website. Available at: http://www.childhoodbraintumor.org/index.php/treatments.html . Accessed August 18, 2009.

    Tumor and treatment info. American Brain Tumor Association website. Available at: http://www.abta.org/Tumor%5FAnd%5FTreatment%5FInfo/12 . Accessed August 18, 2009.

    Understanding brain tumors. International Radiosurgery Support Association website. Available at: http://www.irsa.org/brain%5Ftumors.html . Accessed August 18, 2009.

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