Chemotherapy drugs for brain tumours

Not all chemotherapy drugs are suitable for treating brain tumours. This is because some chemotherapy drugs cannot cross the natural protection filter around the brain (the blood-brain barrier). But some drugs can, including

• Procarbazine
• Carmustine (BCNU)
• Lomustine (CCNU)
• Irinotecan
• Temozolomide
• Cisplatin and carboplatin
• Methotrexate
• Etoposide
• Cyclophosphamide
• Ifosfamide
• Vincristine
• Other

Temozolomide, procarbazine and lomustine are all made as capsules or tablets, so you can swallow them. That means you can have your treatment at home, as an outpatient.

Procarbazine

Your specialist may suggest procarbazine on its own or in combination with other chemotherapy drugs. The most widely used combination for brain tumours is PCV, which is procarbazine, lomustine (CCNU) and vincristine. The most common side effects of procarbazine are

• Low blood cell counts
• Feeling and being sick
• A flu like syndrome with headaches, a temperature, aching and tiredness
• Central nervous system effects - such as anxiety, depression, nightmares, sleeplessness and lack of energy

Procarbazine can react with alcohol and non alcoholic beers and wine, making you sick, dizzy or breathless. So, when you are taking this drug (and for 2 weeks afterwards) it is best to avoid these types of drink. More rarely, procarbazine can react with particular foods such as mature cheese, yeast or meat extract, salami and overripe fruit. As this is rare, you can try eating any of these, but it is a good idea to have a small amount at first to see if you are going to react. There is more about this, and about all the side effects of procarbazine in the cancer drugs section.

Carmustine (BCNU)

You can have carmustine into a vein, through a drip. If you are having it on its own, it is most common to have it every 6 weeks. Or you may have it in combination with other chemotherapy drugs. The most common side effects are

• Low blood cell counts
• Feeling and being sick
• Pain in your vein while having the drip
• Diarrhoea
• Headaches

You can also have carmustine as small wafers implanted into your brain during surgery. Side effects of carmustine implants might include

• Swelling of the brain (oedema)
• Convulsions
• Problems with wound healing
• Infections at the operation site

There is a page about the specific side effects of carmustine in the cancer drugs section.

Lomustine (CCNU)

Lomustine is a tablet. You usually take a single dose every 6 weeks. You may have it in combination with other drugs. The commonest side effects include

• Low blood cell counts
• Feeling and being sick
• Reaction with alcohol or other drugs
• Loss of appetite

There is a page about the specific side effects of lomustine in the cancer drugs section.

Irinotecan

You have irinotecan (Campto) into a vein, through a drip. You may have it as part of trials combining it with other chemotherapy drugs or biological therapies such as bevacizumab (Avastin). The most common side effects of irinotecan include 

• Diarrhoea
• Tiredness
• Feeling and being sick
• Low blood cell counts

Temozolomide

Temozolomide is used on its own to treat brain tumours. It can be used to treat newly diagnosed glioblastoma multiforme tumours in people who are fairly fit and well. It is also used for brain tumours that have come back after they were first treated. The most common side effects include

• Low blood cell counts
• Sickness
• Tiredness
• Sensitivity to the sun

There is a page about the specific side effects of temozolomide in the cancer drugs section.

PCV

This is a common combination of drugs for treating brain tumours. There are 3 drugs: procarbazine, lomustine (CCNU), and vincristine. As well as the side effects listed above for procarbazine, the commonest side effects for this combination include

• Constipation
• Loss of appetite
• Numbness and tingling in hands and feet

There is a page about the specific side effects of PCV in the cancer drugs section.

Other drugs that can be used

Methotrexate injected into the spinal canal can be used to treat some brain tumours, particularly lymphomas in the brain or spinal cord. This type of treatment can cause

• Headaches
• Sickness
• A temperature

Headache and sickness are the most common side effects. They can start almost as soon as the drug is given to you. You have to stay lying down for at least an hour after you have had your injection, to make sure that the chemotherapy can circulate around your brain. Very rarely, this type of treatment can cause fits (jerking of arms and legs and a short period of unconsciousness). This is rare, so if you are worried by it, talk to your nurse or doctor for reassurance.

Pineal germinomas are tumours that are similar to some types of cancer of the testicle or ovary. So they are treated with drugs that these types of tumours respond to. Your specialist will of course, decide your exact treatment. But the drugs given could include any of these

• Cisplatin
• Bleomycin
• Vinblastine
• Actinomycin (Dactinomycin)
• Cyclophosphamide

Young children with primitive neuroectodermal tumours, ependymomas or some types of glioma may have chemotherapy instead of radiotherapy. This is so that they do not have to have radiotherapy at a very young age. Your child's specialist will decide the exact treatment, but the drugs used can include

• Cyclophosphamide
• Vincristine
• Cisplatin
• Etoposide
• Carboplatin
• High dose methotrexate

Click on the links for information about the side effects of these drugs.