Medications for astrocytoma of the brain

Chemotherapy for brain astrocytoma should be distinguished from concomitant symptomatic therapy. As CNS tumors grow, they disrupt the circulation of cerebrospinal fluid in the brain, which causes herpetic-hydrocephalic syndrome. This is what patients often seek medical attention for, without suspecting the true cause of the disease.

Fluid retention in the central nervous system leads to edema, which means that to alleviate the patient's condition, it is necessary to carry out anti-edema therapy, and anti-inflammatory drugs are prescribed for the treatment of cancer. [ 1 ] For this purpose, 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. To prevent them, antiulcer drugs from the category of H2-gitamine receptor blockers (Ranitidine) are prescribed.

In astrocytomas of a certain localization, the characteristic symptom is the occurrence of epileptic seizures. In such a situation, both before and after the operation, the patient is prescribed anticonvulsant therapy. Similar prescriptions are made for patients whose electroencephalogram shows signs of epileptiform activity. Although often such treatment has a purely prophylactic purpose to prevent the occurrence of epileptic seizures.

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

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

As for postoperative treatment, an important point is the prescription of anticoagulants. During any operation, a significant amount of a substance that increases blood clotting enters the circulatory system. This is a protective mechanism that can do a disservice. Low activity after surgery plus high blood clotting is a direct path to the formation of blood clots, which can subsequently block the pulmonary artery. [ 6 ]

Pulmonary embolism (PE) is an extremely dangerous pathology, which, however, can be prevented with blood thinning drugs. On the 3rd day after surgery, when the risk of bleeding decreases, 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 Gemapaxan, Fraxiparin, Clexane, Fragmin, etc. The drugs are administered subcutaneously or intravenously for 1-1.5 weeks. [ 7 ], [ 8 ]

Pain syndrome in cerebral astrocytomas (frequent and severe headaches) is usually relieved with NSAIDs, which are administered orally or by injection. But if it comes to severe pain that cannot be relieved by conventional painkillers (and this is a common situation with stage 4 tumors), they resort to the help of narcotic analgesics to somehow alleviate the suffering of the doomed person.

Drug treatment

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

In other words, we are talking about symptomatic therapy. And although it is impossible to cure the disease with its help, by removing its unpleasant manifestations, it is possible to give a person hope for the best, prevent the development of severe depression and the emergence of a feeling of hopelessness. After all, the result of cancer treatment largely depends on the patient's attitude.

What drugs make the life of a patient with a brain tumor less painful and dangerous? These are corticosteroids in combination with antiulcer drugs, diuretics, anticonvulsants, anticoagulants and painkillers. Let us dwell in more detail 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 for preventive purposes.

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

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

Tablets should be taken whole, without chewing or breaking, so 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 a person with a diseased liver, and the result obtained differs from the mass of the whole tablet, they tend to such a dosage that corresponds to the closest minimum value that the whole tablet can contain. For example, if the calculation yielded a figure of 35, then the patient is prescribed a dose of 25 mg, corresponding to a whole tablet. The same dose should be received by those who, according to the calculations, should have been prescribed 40 or 45 mg.

The standard initial dosage of the drug, when used as monotherapy, is 25 mg twice a day. After 2 weeks, the regimen is changed and the drug is taken once a day at 50 mg for 2 weeks. In the future, it is recommended to increase the dose by 50-100 mg every 1-2 weeks, monitoring the patient's condition. The optimal dose is strictly individual; for one, 100 mg per day is enough, while for another, all 500 mg are needed to achieve improvement.

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

In case of epileptic seizures in children with cerebral astrocytoma, the dosage of Lamotrigine is calculated based on the patient's weight. 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 the patient is given medication at a rate of 0.4 mg per day per kilogram of weight 1 or 2 times a day. Then, as in adults, the dose is gradually increased every 1-2 weeks until the desired effect is achieved. [ 10 ]

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

The drug can be prescribed to any patient over 3 years of age, if he/she has no hypersensitivity to the components of the drug. Caution in dosing should be observed in severe liver and kidney diseases, as well as when it comes to children.

Pregnant women are prescribed Lamotrigine taking into account the risk ratio for the mother and fetus. During lactation, the ability of the active substance to penetrate into breast milk must be taken into account.

Side effects may be associated with high dosage, hypersensitivity or co-administration of lamotrigine with sodium valproate. Such symptoms may include skin rashes, blood composition and properties disorders, headaches, dizziness, nausea, impaired coordination, involuntary eye movements, sleep disorders, hallucinations, movement disorders, etc. Increased seizures and liver dysfunction are possible.

If lamotrigine is prescribed as monotherapy, unpleasant symptoms may include visual impairment and inflammation of the conjunctiva of the eyes, irritability, fatigue, and sleep disturbances.

"Keppra" is an antiepileptic drug with the active substance levetiracetam, produced in tablets of different dosages, as a concentrate from which an infusion solution is prepared, and as a solution for oral administration. This drug can be used to treat even infants from 1 month old, using an oral solution. [ 11 ]

The infusion solution is prepared by dissolving the concentrate in saline or Ringer's solution. Droppers are administered twice a day. The patient can be switched to oral administration and back while maintaining the dosage and number of doses.

For patients over 16 years of age, the initial dose is 250 mg twice a day. After 2 weeks, the daily dose is doubled while maintaining the frequency of administration. A further increase in dosage is possible, but not more than 3000 mg per day.

For children under 16, the drug is prescribed as part of a complex therapy, calculating the doses individually. At first, the dosage is calculated as 10 mg per kilogram of weight twice a day, after 2 weeks the dose is doubled, etc. The recommended single dose for two-time administration is 30 mg per kilogram of weight, but the doctor should be guided by the patient's condition and, if necessary, adjust the dose to the minimum effective.

The drug is administered intravenously for no more than 4 days, after which they switch to tablets while maintaining the dosage recommendations.

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

Infants under six months are prescribed an initial dose of 14 mg per kilogram of body weight, divided into 2 doses. After 2 weeks, the dose is doubled with the same frequency of administration. If necessary, after 4 weeks from the start of treatment, the patient may be prescribed a dosage of 42 mg/kg per day (in 2 doses).

Children from six months to 16 years are prescribed 20 mg per kilogram of weight per day (in 2 doses). The first 2 weeks the child takes 10 mg/kg at a time, the next 2 weeks - 20 mg/kg, then if necessary the dose is increased 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 are given to children over 4 years old. The possibility of using the drug during pregnancy and breastfeeding should be discussed with a doctor.

Frequent inflammation of the nasopharyngeal mucosa, drowsiness, headaches and dizziness, ataxia, convulsions, hand tremors, depression, irritability, sleep disorders, cough are associated with the use of the drug. It can cause lethargy, anorexia, increased fatigue, abdominal discomfort, skin rashes and other unpleasant symptoms.

"Fraxiparin" is an antithrombotic agent (anticoagulant) from the category of low-molecular heparins, which is administered by injection, acts quickly and for a long time, does not provoke bleeding. It is used as a preventive measure against the formation of blood clots in the postoperative period. [ 12 ]

Only subcutaneous administration of the drug is permitted with regular monitoring of the platelet level. Patients whose weight does not exceed 51 kg are administered 0.3 ml of the drug once a day, with a weight of 51-70 kg the recommended dose is 0.4 ml, over 70 kg - 0.6 ml. Treatment is usually carried out for 10 days, starting from 3-4 days after the operation. 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, severe liver and kidney diseases with impaired organ function, retinopathy, high risk of bleeding, acute infectious inflammation of the endocardium, thrombocytopenia, hypersensitivity to the drug and its components.

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

Almost all low-molecular heparins are administered subcutaneously. No studies have been conducted on their safety for children, so these drugs are not used in pediatric practice. The decision to use antithrombotic agents in children is made by the attending physician, who selects the appropriate drug.

We have reviewed some of the drugs that may be part of symptomatic therapy for brain astrocytoma. They do not cure the disease, unlike chemotherapy drugs. These are quite aggressive drugs that have a detrimental effect on the immune system and cause multiple side effects, but without their help, surgical treatment of malignant neoplasms does not always give a lasting effect.

"Temodal (Temozolomide)" is one of such aggressive chemotherapy agents that can change the properties of atypical cells, leading to their death. The drug is prescribed for multiform glioblastoma (in combination with radiation therapy), anaplastic astrocytoma, recurrent malignant gliomas, and in cases of suspected possible degeneration of benign tumor cells. It can be used to treat patients from 3 years old. [ 13 ]

"Temodal" is available in capsule form (several dosages from 5 to 250 mg). The capsules should be taken on an empty stomach with a glass of water. You can eat no earlier than an hour after taking the medicine.

Treatment regimens are prescribed based on the diagnosis. For glioblastoma, Temodal is initially prescribed for a 42-day course together with radiotherapy (30 fractions, 60 Gy in total). The daily dose of the drug is calculated as 75 mg per square meter of body surface. During this time, the patient must be under the supervision of specialists who decide on a possible break in treatment or its cancellation in case of poor tolerance.

At the end of the combined course, take a 4-week break, then switch to monotherapy with Temodal, 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 begins with a dosage of 200 mg/m2. Take the drug for 5 days and take another break. All other cycles are similar to the second with the same dosage.

If the dose is poorly tolerated, it is not increased after the first cycle or is gradually reduced (to 100 mg/m2) if signs of severe toxicity appear.

Treatment of anaplastic and recurrent malignant astrocytomas is carried out in a 28-day course. If the patient has not previously undergone chemotherapy, he is prescribed the drug at a dosage of 200 mg/m2. After 5 days of treatment, a break of 23 days is required.

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

In case of severe liver and kidney pathologies, the dose must be adjusted and the condition of the organs must be constantly monitored.

The drug is not prescribed to patients with hypersensitivity to it, as well as in case of low white blood cell and platelet counts in the blood, since myelosuppression (reduced concentration of these blood elements) is one of the common side effects of chemotherapy. The drug is prescribed to children 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 common side effects of the drug for treating brain astrocytoma, regardless of the degree of malignancy, are nausea, vomiting, bowel disorders, hair loss, headaches, weight loss and fatigue. Quite often there were complaints of seizures, skin rashes, infections (result of suppression of the immune system), changes in blood composition, sleep disorders, emotional instability, deterioration of vision and hearing, swelling of the legs, hemorrhages, dry mouth and abdominal discomfort. Such manifestations as muscle weakness, joint pain, taste changes, allergic reactions are also common. Blood tests may show an increase in ALT levels, which indicates the destruction of liver cells.

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