ART OF MEDICINE 2017
MORBIDITY CHARACTERIS-TICS AND CHEMOTHERAPEU-TIC TREATMENT REVIEW OF MALIGNANT CEREBRAL NEO-PLASMES
T.I. Teren1, S.S. Goroshko2, I.M Perkatyuk2, E.V. Graf2
Abstract. In recent years, definition of some genetical abnormalities has become an important predictor of malignant cerebral neoplasmes: astrocytomas, olygodendroglyomas, mixed glyomas and glyoblastomas. Consequently, these abnormalities can be followed at treatment. Modern researches direct to scrutinity of moleculary and genetical mechanismes, and permit to educe essential divergencies of histologically identical neoplasmes. Тhese divergencies have prognostic sense and are recommended by clinical protocols for treatment of malignant cerebral neoplasmes. There are included criteria, such as availability (MGMT), deletion 1q/19q, mutation IDH1/IDH2.
Timely conducted diagnosis and optimally reasonable comlex treatment allow achieving survival patients with astrocytomas І-ІІ stage. 2-20 years, with astrocytomas ІІІ stage 1-8 years, with glyoblastomas 1-5 years, with olygodendrocytomas 3-15 years.
The standard-of-care treatment for high-grade malignant glioma is a combination of surgery, radiation therapy, and oral chemotherapy with or without implantation of the Gliadel wafer in the tumor cavity during surgery. Radiation therapy starts a few weeks after surgery and takes place 5 days per week for 6 weeks. Concomitant treatment with the chemotherapeutic agent Temodar (the generic name is temozolomide) starts at the same time as radiation therapy. The standard-of-care treatment for high-grade glioma is also called the “Stupp” protocol, named after Roger Stupp, MD, the lead investigator of the randomized controlled trial of the treatment, which was organized by the European Organisation for Research and Treatment Cancer (EORTC) and the National Cancer Institute of Canada (NCIC) Clinical Trials Group. This study found that the addition of oral Temodar chemotherapy to surgery and radiotherapy significantly improved outcomes in patients with GBM. After the 6-week course of radiation therapy and Temodar is completed, treatment with Temodar continues (referred to as “adjuvant therapy” from that point forward). For patients with glioblastoma multiforme (GBM), Temodar is approved by the FDA for six 28-day cycles of adjuvant therapy, with the drug administered on days 1 to 5 of each 28-day cycle. In practice, Temodar is given until it either stops working or is no longer needed, as determined by a lack of tumor growth for a few months as seen by different imaging scans.
Similarly, for the precise FDA indication of “recurrent glioblastoma multiforme,” the Gliadel wafer and Avastin have been approved. Avastin binds to a protein called vascular endothelial growth factor (VEGF). This may prevent the growth of new blood vessels that tumors need to grow. It is a type of antiangiogenesis agent and a type of monoclonal antibody.
It is the standard-of-care chemotherapeutic agent for the treatment of newly diagnosed brain tumors, and it is approved by the FDA specifically for that use. PCV is a combination of the three chemotherapeutic drugs procarbazine, CCNU, and vincristine. Delivered in part orally and in part intravenously.
It is now a second-line treatment for when Temodar does not work, but it is sometimes used as a first-line treatment for oligodendroglioma. A test is available to tell whether an oligodendroglioma will be sensitive to PCV.
Brain Tumor Guide is for the Newly Diagnosed to spread the infection. With ingestion of the Toca FC antibiotic, the process starts over again and is repeated until the entire tumor has potentially gone. Toca-511 gene therapy is still in clinical trials. Immunotherapy including vaccines, is one of the greatest areas of research for brain tumors. A large number of different immunotherapy clinical trials for brain tumors are performed currently. Immunotherapy is the treatment of disease by enhancing the body’s immune system response to a pathogen. There are two main types of vaccine approaches:
Personalized vaccines. Personalized vaccines require a tumor specimen be sent to a laboratory to identify tumor-specific antigens (proteins) on the surface of the tumor cells. Specific tumor antigens are combined with patient dendritic cells - a type of immune cell found in tissue - to form a personalized vaccine. These antigens stimulate an immune response, activating killer T immune cells to destroy the tumor. Results from a phase I clinical trial of the personalized cancer vaccine DC Vax®-L found that patients with GBM receiving a personalized vaccine survive more than twice as long patients receiving just standard-of-care treatment. Please note: If you are interested in treatment with a personalized vaccine, you must make arrangements before surgery to have the vaccine made or to have frozen tissue stored so that you can have the vaccine made later.
Conclusions. Radiation therapy can cause vascular injury and increase the risk of stroke. Unfortunately, stroke is fairly common among long-term survivors of brain tumors and can be either completely asymptomatic or completely devastating, depending on the location. Stroke risk can be reduced in some patients with diet, aspirin, and other preventive measures. Another long-term side effect of radiation therapy is cognitive loss, which varies with the dose of radiation and the volume and location radiated. Cognitive loss is nearly universal with whole brain radiation.
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