Medications for brain astrocytoma

Chemotherapy for astrocytoma of the brain must be distinguished from concomitant symptomatic therapy. CNS tumors, as they grow, disrupt the circulation of cerebrospinal fluid in the brain, which becomes the cause of the hypertensive-hydrocephalic syndrome. It is with him that patients often turn to doctors, unaware of the true cause of the disease.

Fluid retention in the central nervous system leads to edema, which means anti-edema therapy should be given to alleviate the patient's condition, anti-inflammatory drugs are prescribed to treat cancer. [1]To this end, patients are prescribed corticosteroids (prednisolone, dexamethasone) [2], diuretics from the category of saluretics and osmotic diuretics ("Furosemide", "Mannitol", etc.).[3]

The use of steroid drugs is fraught with complications from the gastrointestinal tract. For their prophylaxis, anti-ulcer drugs are prescribed from the category of H2-gitamine receptor blockers (Ranitidine).

With astrocytomas of a specific location, a characteristic symptom is the appearance of epileptic seizures. In such a situation, both before and after the operation, the patient is prescribed anticonvulsant therapy. Similar assignments are made to patients whose electroencephalogram has signs of epileptiform activity. Although often this treatment has a purely prophylactic goal to prevent the occurrence of epiphriscuses.

When prescribing anticonvulsants (anticonvulsants), it is important to consider their effect on the organs involved in the metabolism of active substances. If chemotherapy is prescribed to the patient, the choice of drugs should be made taking into account their negative effects on the liver (recall that chemotherapy drugs are highly hepatotoxic). Among the safest anticonvulsants in this regard are Lamotrigine, valproic acid preparations, Levetiracetam (Kepra), Carbamazepine and Phenytoin.[4]

Popular preparations "Finlepsin", "Phenobarbital" and some others have a negative effect on the liver, so they can be used only for benign tumors that do not require chemotherapy. [5]

As for postoperative treatment, an important point is the appointment of anticoagulants. During any operation, a significant amount of a substance that increases blood clotting enters the blood circulation system. This is a defense mechanism that can serve unkindly. Low activity after surgery plus high blood clotting is a direct way to the formation of blood clots, which can later block the pulmonary artery.[6]

Pulmonary artery thromboembolism (BODY) is an extremely dangerous pathology, which, however, can be prevented with blood thinners. On day 3 after surgery, when the risk of bleeding is reduced, patients are prescribed low molecular weight heparins, which show a predictable effect, have a long half-life and do not require constant monitoring of blood clotting. These include "Gemapaksan", "Fraksiparin", "Kleksan", "Fragmin", etc. The drugs are administered subcutaneously or intravenously within 1-1.5 weeks.[7], [8]

Brain astrocytoma pain syndrome  (frequent and severe headaches) is usually relieved with the help of NSAIDs, which are administered by mouth or by injection. But if it comes to severe pains that are not appeased by conventional painkillers (and this is a common situation for grade 4 tumors), they resort to the help of narcotic analgesics in order to somehow alleviate the suffering of the doomed person.

Drug treatment 

Chemotherapy of malignant tumors and those prone to degeneration into cancer is one of the full-fledged methods that not only remove the symptoms of the disease, but also treat it, destroying cancer cells. Drug treatment with other drugs, other than those used in chemotherapy, for brain tumors provides only relief to the patient by reducing the intensity of the painful symptoms.

In other words, we are talking about symptomatic therapy. And although the disease cannot be cured with its help, removing its unpleasant manifestations can give a person hope for the best, prevent the development of severe depression and the emergence of a sense of hopelessness. After all, the result of cancer treatment depends on the mood of the patient.

What drugs make the life of a patient with a brain tumor less painful and dangerous? These are corticosteroids in combination with anti-ulcer drugs, diuretics, anticonvulsants, anticoagulants and painkillers. Let us dwell on the recommended antiepileptic drugs, which are prescribed both in the case of existing attacks and for their prevention, and anticoagulants prescribed in the postoperative period with a preventive purpose.

“Lamotrigine” is an anticonvulsant in the form of tablets with relatively low hepatotoxicity. This drug can be prescribed even for patients with moderate and severe liver failure, provided the dose is reduced by 50 and 75%, respectively. In pediatrics, it is used from 3 years of age. [9]

This drug helps to reduce the frequency and intensity of epileptic seizures and prevents mental disorders.

Tablets need to be taken entirely, without chewing and breaking, therefore care must be taken when calculating the dosage. Lamotrigine is available in 25, 50, and 100 mg tablets. If the dose is calculated for a child or person with a diseased liver, and the result obtained differs from the mass of the whole tablet, incline to a dosage that corresponds to the closest minimum value that the whole tablet may contain. For example, if the calculation turned out the figure 35, then the patient is prescribed a dose of 25 mg, corresponding to the whole tablet. Those who, according to calculations, should have been prescribed 40 or 45 mg, should receive the same dose.

The standard initial dosage of the drug provided monotherapy is 25 mg twice a day. After 2 weeks, they change the regimen and take the medicine once a day, 50 mg for 2 weeks. In the future, it is recommended every 1-2 weeks to increase the dose of 50-100 mg, controlling the condition of the patient. The optimal dose is purely individual, one is enough 100 mg per day, the other needs 500 mg to achieve improvement.

If Lamotrigine is prescribed in combination with other anticonvulsants, the dosage will be lower.

In the case of epileptic seizures in children with brain astrocytoma, the dosage of "Lamotrigine" is calculated based on the weight of the patient. A child under 12 years of age should receive the drug at a rate of 0.3 mg per 1 kg of weight (1-2 doses) per day. This treatment lasts 2 weeks, after which 1 or 2 times a day the patient is given medication at the rate of 0.4 mg per day for each kilogram of weight. Further, as in adults, the dose is increased gradually every 1-2 weeks until the desired effect is achieved.[10]

The duration of drug treatment is determined by the physician, since in this case everything depends on the behavior of the tumor and the possibilities of its removal.

The drug can be assigned to any patient over 3 years old, if he does not have hypersensitivity to the components of the drug. Caution in dosing must be observed in severe liver and kidney diseases, as well as when it comes to children.

Pregnant women "Lamotrigine" prescribed taking into account the ratio of risks to the mother and fetus. Lactation must take into account the ability of the active substance to penetrate into breast milk.

Side effects may be associated with high dosage, hypersensitivity, or co-administration of lamotrigine with sodium valproate. These symptoms include skin rash, disturbed blood composition and properties, headaches, dizziness, nausea, poor coordination of movements, involuntary eye movements, sleep disorders, hallucinations, movement disorders, etc. May increase seizures, liver failure.

If lamotrigine is prescribed as monotherapy, visual disturbances and inflammation of the conjunctiva of the eyes, irritability, fatigue, and sleep disorders can become unpleasant symptoms.

"Keppra" is an antiepileptic drug with the active substance levetiracetam, produced in tablets of different dosages, in the form of a concentrate, from which an infusion solution is prepared, and solution for oral administration. Even infants from 1 month can be treated with this drug using an oral solution.[11]

The solution for infusion is prepared by dissolving the concentrate in saline or Ringer's solution. Droppers put 2 times a day. The patient can be transferred to the oral intake and back with the preservation of the dosage and the number of doses.

For patients older than 16 years, the initial dose is 250 mg twice a day. After 2 weeks, the daily dose is doubled, with the same dose. It is also possible to further increase the dosage, but not more than 3000 mg per day.

Children under 16 years of medication prescribed as part of complex therapy, calculating doses individually. First, the dosage is calculated as 10 mg per kilogram of body weight twice a day, after 2 weeks the dose is doubled, etc. The recommended single dose for a double dose is 30 mg per kilogram of weight, but the doctor must be guided by the patient's condition and, if necessary, adjust the dose to the minimum effective.

Intravenous drug is administered for no more than 4 days, after which they are transferred to tablets with preservation of recommendations for dosing.

The oral solution is convenient for treating small children. The required dose is measured by means of syringes 1, 3, 10 ml (sold with the medicine), which corresponds to 100, 300 and 1000 mg of levetiracetam. The divisions available on syringes help to measure the calculated dose.

Babies up to six months prescribed as an initial dose of 14 mg per kilogram of body weight, divided into 2 doses. After 2 weeks, the dose is doubled at the same frequency of use. If necessary, after 4 weeks from the start of treatment, the patient may be prescribed a dosage of 42 mg / kg per day (2 doses).

Children from six months to 16 years per day prescribed 20 mg per kilogram of weight (in 2 doses). The first 2 weeks the child takes at once 10 mg / kg, the next 2 weeks - 20 mg / kg, then, if necessary, increase the dose to 30 mg / kg per dose.

The drug is not prescribed for individual sensitivity to the components. Oral administration is not recommended for fructose intolerance, as well as at the age of less than 1 month. Droppers put children older than 4 years. The possibility of using the drug during pregnancy and breastfeeding should be discussed with your doctor.

Frequent inflammations of the mucous membrane of the nasopharynx, drowsiness, headaches and dizziness, ataxia, convulsions, trembling in the hands, depression, irritability, sleep disturbances, cough are associated with the use of the drug. May cause lethargy, anorexia, increased fatigue, abdominal discomfort, skin rash and other unpleasant symptoms.

“Fraksiparin” - an antithrombotic agent (anticoagulant) from the category of low molecular weight heparins, which is injected, acts quickly and for a long time, does not provoke bleeding. It is used as a prevention of the formation of blood clots in the postoperative period.[12]

Only subcutaneous administration of the drug is permitted with regular monitoring of platelet levels. For patients whose weight does not exceed 51 kg, 0.3 ml of the drug is administered once a day, with a weight of 51-70 kg, the recommended dose will be 0.4 ml, over 70 kg - 0.6 ml. Treatment is usually carried out within 10 days, starting from 3-4 days after surgery. During the course of treatment, the dose remains unchanged.

The drug has a decent list of contraindications. It is not prescribed to children, pregnant women, nursing mothers, with severe liver and kidney diseases with impaired organ function, retinopathy, high risk of bleeding, acute infectious inflammation of the endocardium, thrombocytopenia, and hypersensitivity to the drug and its components.

Frequent side effects of taking anticoagulants are considered to be bleeding (in the presence of diseases with a tendency to bleeding and traumatic injuries), reversible disruption of the liver, the formation of hematomas at the injection site. Hypersensitivity reactions and anaphylaxis occur very rarely.

Virtually all low molecular weight heparins are injected subcutaneously. Research on their safety for children has not been conducted, so in pediatric practice, these drugs are not used. The decision on the use of antithrombotic agents in children is made by the attending physician, who selects the appropriate drug.

We looked at some of the remedies that may be part of symptomatic therapy for brain astrocytoma. They do not cure the disease, unlike chemotherapy drugs. These are rather aggressive agents that have a detrimental effect on the immune system and cause multiple side effects, but without their help, prompt treatment of malignant tumors does not always produce a lasting effect.

Temozolomide is one of these aggressive chemotherapy drugs that can alter the properties of atypical cells, leading to their death. The drug is prescribed for glioblastoma multiforme (in combination with radiation therapy), anaplastic astrocytoma, recurrent malignant gliomas, as well as in cases of suspected possible degeneration of benign tumor cells. With it, you can treat patients from 3 years.[13]

"Temodal" produced in the form of capsules (several dosages from 5 to 250 mg). Take the capsules on an empty stomach with a glass of water. Eating can be no earlier than one hour after taking the medicine.

Treatment regimens prescribed based on the diagnosis. When glioblastoma “Temodal is first prescribed a course of 42 days along with radiotherapy (30 fractions, total 60Gy). The daily dose of the drug is calculated as 75 mg per square meter of body surface. All this time, the patient should be under the supervision of specialists who decide on a possible interruption in treatment or its cancellation with poor tolerance.

At the end of the combined course, a 4-week break is made, after which they are transferred to Temodal monotherapy, which includes 6 cycles. The recommended dose varies from cycle to cycle. First, it is 150 mg / m2 per day for 5 days, then a break for 23 days. The second cycle starts with a dosage of 200 mg / m2. Drink the drug for 5 days and again take a break. All other cycles are similar to the second with the same dosage.

With poor tolerance, the dose after cycle 1 is not increased or gradually reduced (to 100 mg / m2) when signs of strong toxicity appear.

Treatment of anaplastic and recurrent malignant astrocytomas is carried out in a course of 28 days. If a patient has not previously undergone chemotherapy, he is prescribed a drug at a dosage of 200 mg / m2. Having been treated for 5 days, you need to take a break for 23 days.

In the case of repeated chemotherapy, the initial dose is reduced to 150 mg / m2 and increased in the second cycle to 200 mgm2 only in the case of normal tolerance.

In the case of severe pathologies of the liver and kidneys, the dose needs to be adjusted and the state of the organs should be constantly monitored.

The drug is not prescribed to patients with hypersensitivity to it, as well as in the case of a low number of leukocytes and platelets in the blood, since myelosuppression (a decrease in the concentration of these blood elements) is one of the frequent side effects of chemotherapy. For children, the drug is prescribed from the age of 3; it is not used during pregnancy and breastfeeding (it has a teratogenic effect and penetrates into breast milk).

The most frequent side effects in the treatment of brain astrocytomas, regardless of the degree of malignancy, are nausea, vomiting, abnormal stool, hair loss, headaches, weight loss and fatigue. Quite often there were complaints of convulsions, skin rashes, infections (the result of depressed immunity), changes in blood composition, sleep disorders, emotional instability, blurred vision and hearing, leg swelling, hemorrhage, dry mouth and abdominal discomfort. Such manifestations as muscular weakness, pain in the joints, changes in taste, and allergic reactions are also frequent. A blood test can show an increase in ALT levels, indicating that the liver cells are destroyed.

Other side effects are possible, but less likely. True, some of them are less harmless than the above. So chemotherapy is a blow not only to the cancer cells, but also to the whole body, so it is recommended to prescribe it only when there are good reasons for this.