Chemotherapy for Brain Cancer
Chemotherapy is a treatment that uses one or more aniti-cancer medicines to kill cancer cells or slow cancer growth. It may be used to shrink a tumour before surgery (neo-adjuvant therapy), to destroy remaining cancer cells aftersurgery or radiation (adjuvant therapy), to improve symptoms or to prolong quality of life.
How Chemotherapy Works and Reaches Tumours
Chemotherapy is a brain tumour treatment option that uses drugs to stop cancer growth or kill cancer cells. These drugs damage the DNA of cancer cells, leading to cell death, ultimately helping to slow or shrink tumour growth.
Unlike surgery and radiotherapy, which target a defined area, chemotherapy systemically treats brain tumours and can reach infiltrating tumour cells beyond the main tumour mass. However, its effectiveness in brain cancer is limited by the blood-brain barrier and tumour biology.
Chemotherapy for brain tumours can be given in several ways, depending on the drug and the type of brain tumour. It is most commonly administered intravenously through a vein or taken orally as tablets or capsules. In selected cases, chemotherapy may be delivered directly into the fluid surrounding the brain and spinal cord to bypass the blood-brain barrier.
Timing of Chemotherapy
In brain cancer, chemotherapy is most commonly given after surgery, either alongside radiotherapy (the concomitant phase) or as ongoing treatment afterwards (the adjuvant phase). In selected cases, chemotherapy may be given before surgery, known as neoadjuvant treatment, although this approach is not routine and is usually limited to specific tumour types or clinical trials.
When used before surgery in selected cases, chemotherapy aims to reduce tumour burden (size, number and volume of tumours) and support surgical removal. When given after surgery, it is used to target residual tumour cells that cannot be safely removed and to help delay tumour regrowth.
When Is Chemotherapy Used for Brain Cancer?
Brain cancer chemotherapy may be used at different points in brain tumour care, depending on tumour type and molecular profile. For example:
- Chemotherapy can be combined with radiotherapy following surgery to improve treatment effectiveness when given alongside radiotherapy. This is called the ‘chemoradiation’ treatment regime.
- Chemotherapy may also be given after surgery and radiotherapy, commonly for several months (adjuvant chemotherapy), with duration varying by tumour type and patient factors.
- If the tumour comes back or continues to grow after initial treatment (tumour recurrence), chemotherapy may be used as a further treatment option.
Brain Cancer Chemotherapy for Children
Treatment for adult brain cancer differs substantially from that for paediatric brain cancer. In adults, cancer usually develops due to genetic mutations that accumulate and age-related biological processes. In contrast, childhood cancers typically arise from random genetic mutations that occur early during development.
Because of these fundamental biological differences, and the distinct genetic drivers involved in adult versus paediatric cancers, treatment approaches also differ significantly. Fortunately, some childhood brain tumours are more sensitive to treatment, including chemotherapy.
Major Chemotherapy Drugs for Brain Cancer
Chemotherapy drugs used to treat brain cancer are grouped based on their chemical makeup and how they destroy cancer cells. Doctors decide which chemotherapy to use based on results from clinical trials, where certain drugs have shown better outcomes with manageable side effects for specific tumour types and patient factors. They also consider the biology of the tumour, especially if earlier (first-line) treatments have already been given.
Common Chemotherapy Drugs
Below are some common chemotherapy drugs for brain cancer treatment in Australia that you may hear your care team discuss, depending on the type of brain tumour.
Temozolomide
Temozolomide is one of the most commonly prescribed chemotherapy drugs for newly diagnosed and recurrent malignant brain tumours, particularly gliomas. It can cross the blood-brain barrier and is quickly absorbed by the body. Temozolomide is usually taken as an oral tablet because this route provides good absorption. Patients are often advised to take it on an empty stomach and at the same time each day.
PCV Chemotherapy
PCV chemotherapy is commonly used as adjuvant treatment for some diffuse gliomas, especially oligodendroglial tumours. It combines three drugs: Procarbazine, Lomustine (CCNU), and Vincristine that attack cancer cells in different ways, making the combination more effective than a single drug alone. Procarbazine and lomustine are taken orally, while vincristine is given intravenously (due to limited penetration into the brain) over 10-15 minutes.
Carboplatin
Carboplatin is an intravenous chemotherapy drug that may be used in selected cases for recurrent high-grade glioma. It works by binding to cancer cell DNA, ultimately preventing cell division and inducing cell death. Carboplatin is often used as a third-line treatment and may be given together with bevacizumab.
Bevacizumab
Bevacizumab is a targeted therapy that blocks a protein called VEGF, which tumours use to form new blood vessels. By reducing the tumour’s blood supply, it can help shrink contrast-enhancing tumours on scans and improve progression-free survival in some patients. It may be combined with chemotherapy such as carboplatin in selected recurrent cases, although the best approach remains uncertain.
How Chemotherapy is Administered
Your doctors will recommend the best way to give chemotherapy based on your overall health, how likely the tumour is to respond, and how long treatment is needed. Intravenous and oral chemotherapy are chosen based on the drug, the evidence for your tumour type, expected side effects of chemotherapy, and practical considerations, while oral chemotherapy offers a less invasive option and is commonly used for longer-term maintenance treatment.
Oral Chemotherapy
Oral chemotherapy is cancer treatment taken by mouth, usually as tablets or capsules, allowing patients to take their medication at home rather than in a hospital or clinic. It works by targeting and destroying cancer cells or slowing their growth, but still requires close monitoring by a healthcare team.
Intravenous Chemotherapy
Intravenous (IV) chemotherapy is cancer treatment delivered directly into a vein through a drip or injection, usually in a hospital or treatment centre. This method allows the drugs to enter the bloodstream quickly and circulate throughout the body to target cancer cells.
How Chemotherapy for Brain Tumours Works: The Treatment Process
Once chemotherapy is included in your cancer treatment plan, your oncologist will guide you through several key steps as part of your care. The chemotherapy process for brain cancer includes:
Diagnosis and tumour grading
Chemotherapy is rarely used on its own to treat brain tumours. After surgery, a sample of the tumour is examined by a neuro-histopathologist, who determines the tumour type and grade. Your healthcare team then considers the tumour grade, location, and genetic profile to design a patient-centred treatment plan aimed at controlling tumour growth. At this stage, your doctor will select the most appropriate chemotherapy drug based on evidence from clinical trials and established treatment guidelines. Blood tests are usually performed before treatment begins to check how well your vital organs are functioning, and these tests may be repeated during treatment to ensure chemotherapy is not causing harm to these organs.
Establishing the treatment plan
Chemotherapy is typically given in cycles. A cycle usually involves receiving treatment either intravenously over a defined period or orally for several consecutive days, followed by a rest period to allow normal cells to recover. When chemotherapy is given alongside radiation therapy, it often starts within several weeks after surgery. If you are prescribed oral chemotherapy (e.g. Temozolomide), you may take capsules at home each day, preferably at the same time while attending the clinic for radiotherapy over 4-6 weeks.
After a rest period of about 4-6 weeks, your doctors may recommend continuing chemotherapy for several months, often around six cycles, with duration tailored to tumour type and response and how manageable the side effects are. Medications to prevent nausea are commonly provided alongside to help manage vomiting associated with chemotherapy treatment.
Ongoing assessment and monitoring
Your healthcare team will closely monitor you throughout treatment for side effects and changes in your blood counts. Chemotherapy doses may be adjusted if certain red blood cells such as neutrophils and platelets drop below normal range. MRI scans may also be performed to assess tumour response or stability and guide further treatment decisions. After treatment is completed, a long-term follow-up plan is established to monitor for recurrence
Chemotherapy Side Effects
How Chemotherapy Affects Healthy Cells
Chemotherapy can cause side effects because, although it targets cancer cells, some healthy cells can also be affected. Rapidly dividing cells, such as those in the blood, bone marrow, intestines, mouth, nails, and hair, are particularly sensitive to chemotherapy, which leads to many of the common side effects.
Common Short-Term Side Effects
Some short-term side effects that may appear soon after treatment begins include:
- Nausea
- Fatigue
- Reduced appetite (which may contribute to weight loss)
- Mouth ulcers
- Diarrhoea
- Constipation
- Hair loss
The type and severity of side effects vary depending on the chemotherapy drug used and the patient’s overall health. Doctors may prescribe antiemetic medications to help manage nausea and vomiting.
Chemotherapy and Immune Suppression
One of the major dose-limiting toxicities of chemotherapy is immunosuppression. This occurs when chemotherapy affects bone marrow cells responsible for producing immune cells. A reduction in white blood cells increases the risk of infections that may take longer to resolve, while low platelet levels can lead to prolonged bleeding.
If white blood cell counts do not return to normal, doctors may pause treatment until recovery occurs, reduce the chemotherapy dose, or may prescribe antibiotics in selected cases to lower the risk of infection. In some cases, colony-stimulating factors (CSFs), also known as white blood cell growth factors, may be given between chemotherapy cycles to support immune recovery.
Certain drugs, such as lomustine (part of the PCV regimen), can cause delayed immune suppression. For this reason, blood tests are often continued for at least six weeks after treatment completion to ensure blood counts remain safe.
Peripheral Neuropathy and Cognitive Effects
Chemotherapy can also damage healthy cells and peripheral nerves leading to peripheral neuropathy. This is a common side effect of vincristine, another drug in the PCV regimen, and may cause tingling or numbness in the hands and feet.
Chemotherapy can also contribute to cognitive changes, often described as ‘chemobrain,’ although these effects may also be influenced by the tumour itself, surgery, radiotherapy, and other treatments.
How Effective Is Chemotherapy for Brain Cancer?
Does chemotherapy cure brain cancer? Chemotherapy effectiveness varies widely. Unlike many other cancers, brain tumours present unique biological and physical barriers that limit how well chemotherapy works. As a result, chemotherapy is often more effective for certain tumour types and molecular profiles than others, and its role is frequently to control tumour growth rather than achieve a cure.
Blood-Brain Barrier
One reason chemotherapy is less effective for brain tumours is the presence of the blood-brain barrier. This is a natural protective layer that shields the brain from harmful substances in the blood. While some chemotherapy drugs used for brain cancer, such as temozolomide and the PCV regimen, are able to cross this barrier, drug penetration into tumour tissue is often incomplete and uneven. As a result, the treatment may not work as strongly as it does for cancers elsewhere in the body.
Another challenge is that the blood-brain barrier contains special pumps that actively push drugs back out of the brain. These “drug efflux pumps” reduce the amount of chemotherapy that stays in the brain long enough to affect the tumour. In addition, cancer cells can develop their own ways to protect themselves from chemotherapy, making the drugs less effective over time.
Tumour Heterogeneity and Resistance
Brain tumours are also made up of a mix of different cancer cells. Some cells may respond to chemotherapy, while others do not. When treatment kills the sensitive cells, the resistant cells can survive and continue to grow, leading to treatment resistance. Because of these challenges, chemotherapy is often used to slow tumour growth and manage symptoms in many high-grade tumours, rather than cure most brain cancers.
Tumour grade also influences treatment response. High-grade tumours (grade 3-4) generally have lower chances of long-term response compared with low-grade tumours. However, because chemotherapy targets actively dividing cells, faster-growing or more aggressive tumours may show temporary responses to chemotherapy, although long-term control is uncommon. In these situations, the goal of chemotherapy is usually to slow tumour growth and relieve symptoms, rather than to cure the disease.
Accessing Chemotherapy in Australia
If chemotherapy is recommended, your healthcare team will discuss access and next steps with you. In Australia, chemotherapy is funded through the Efficient Funding for Chemotherapy (EFC) program, which operates under the Pharmaceutical Benefits Scheme (PBS).
Reducing Out-of-Pocket Costs
Through EFC, most chemotherapy medicines are available for a standard PBS co-payment, with the remaining cost covered by the Australian Government. Ongoing or repeat prescriptions are usually provided at the same co-payment cost. Medicines prescribed to help manage chemotherapy side effects, such as anti-nausea treatments, are often subsidised under the PBS.
In addition, if you reach the PBS Safety Net threshold within a calendar year, your medication costs may be further reduced for the remainder of that year, helping to lower out-of-pocket expenses for future prescriptions.
Your treatment team can help explain your individual costs and support options. Further information can be found on the Pharmaceutical Benefits Scheme (PBS)website.
Questions to Ask Your Healthcare Team
Starting chemotherapy comes with a lot of moving parts, and it’s easy to feel like you’re just being pulled along by the process. Asking clear, practical questions can help you understand why a particular treatment is being recommended, what you can realistically expect, and how to prepare for the road ahead. Use the questions below to cut through the guesswork and get the information you actually need from your care team.
What drug is recommended and why?
How long is chemo for brain cancer?
What alternative options are available if chemotherapy is not effective or not tolerated?
Disclaimer: All Cure Brain Cancer Foundation website content is created and published online for informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. You should seek your own medical advice from your doctor or other qualified health professionals.
Whether you’re facing a new diagnosis or supporting a loved one, help is available. Explore a range of support resources, services, and guidance to assist you through every step of the brain cancer journey.
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