Skip to main content
SpringerLink
Log in
Book cover

Management of Adult Glioma in Nursing Practice pp 229–243Cite as

Chemotherapy for Gliomas

  • Chapter
  • First Online:

  • 489 Accesses

Abstract

Standard treatment approaches for adult gliomas consist of surgery, radiotherapy and chemotherapy, based on the histological diagnosis and molecular profile of the specific glioma. Patient performance status and other prognostic factors are also taken into consideration when deciding upon treatment options.

Temozolomide (TMZ), procarbazine, vincristine and lomustine (PCV) are all types of alkylating (e.g. damaging the DNA, affecting the ability of cancer cells to multiply) chemotherapy agents frequently used in the treatment of gliomas. They can be given as initial treatment (either in combination with or adjuvant to radiotherapy) or administered at recurrence. Oncology specialist nurses work closely together with patients receiving chemotherapy, as well as their caregivers. Effective education by the oncology nurse of the patient and his/her caregiver(s) promotes patient safety and well-being, helps maintain optimal dosing and ensures accurate assessment and evaluation of side effects and toxicities. Specialist nurses evaluate the process and initiate supportive therapies as required, such as fatigue management, nutritional advice, psychosocial support and physiotherapy.

Temozolomide, lomustine and procarbazine can cause myelosuppression (also known as bone marrow suppression) and require careful monitoring of full blood counts to prevent complications associated with neutropenia, thrombocytopenia and lymphopenia. Other side effects such as nausea and fatigue are manageable, neuropathy is a specific side effect of vincristine, but all can have significant impacts on quality of life. These side effects and their nursing implications and considerations will be explored in more detail in this chapter.

Interventions such as treatment delay may lead to recovery of the bone marrow function and blood counts. Dose adjustments—if deemed necessary—may allow the patient to continue chemotherapy treatment as long as there is no evidence of tumour progression during treatment. Should a patient’s tumour progress whilst on active chemotherapy treatment, the treating physicians and specialist nurse will need to help manage the patient’s expectations and adjust their goal settings.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD   54.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Armstrong TS, Gilbert MR. Chemotherapy of astrocytoma: an overview. Semin Oncol Nurs. 1998;14(1):18–25.

    Article  CAS  Google Scholar 

  2. Graham CA, Cloughesy TF. Brain tumor treatment: chemotherapy and other new developments. Semin Oncol Nurs. 2004;20(4):260–72.

    Article  Google Scholar 

  3. van den Bent MJ, Brandes AA, Taphoorn MJ, Kros JM, Kouwenhoven MC, Delattre JY, Bernsen HJ, et al. Adjuvant procarbazine, lomustine, and vincristine chemotherapy in newly diagnosed anaplastic oligodendroglioma: long-term follow-up of EORTC brain tumor group study 26951. J Clin Oncol. 2013;31(3):344–50. https://doi.org/10.1200/JCO.2012.43.2229.

    Article  CAS  Google Scholar 

  4. Gorlia T, Delattre JY, Brandes AA, Kros JM, Taphoorn MJ, Kouwenhoven MC, Bernsen HJ, et al. New clinical, pathological and molecular prognostic models and calculators in patients with locally diagnosed anaplastic oligodendroglioma or oligoastrocytoma. A prognostic factor analysis of European Organisation for Research and Treatment of Cancer Brain Tumour Group Study 26951. Eur J Cancer. 2013;49(16):3477–85. https://doi.org/10.1016/j.ejca.2013.06.039.

    Article  PubMed  Google Scholar 

  5. Cairncross G, Wang M, Shaw E, Jenkins R, Brachman D, Buckner J, Fink K, Souhami L, Laperriere N, Curran W, Mehta M. Phase III trial of chemoradiotherapy for anaplastic oligodendroglioma: long-term results of RTOG 9402. J Clin Oncol. 2013;31(3):337–43. https://doi.org/10.1200/JCO.2012.43.2674.

    Article  CAS  PubMed  Google Scholar 

  6. Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, Belanger K, et al. European Organisation for Research and Treatment of Cancer Brain Tumor and Radiotherapy Groups; National Cancer Institute of Canada Clinical Trials Group. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005;352(10):987–96.

    Article  CAS  Google Scholar 

  7. Pignatti F, van den Bent M, Curran D, Debruyne C, Sylvester R, Therasse P, Afra D, et al. European Organization for Research and Treatment of Cancer Brain Tumor Cooperative Group; European Organization for Research and Treatment of Cancer Radiotherapy Cooperative Group. Prognostic factors for survival in adult patients with cerebral low-grade glioma. J Clin Oncol. 2002;20(8):2076–84.

    Article  Google Scholar 

  8. https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/ctcaev3.pdf.

  9. Perry JR, Laperriere N, O'Callaghan CJ, Brandes AA, Menten J, Phillips C, Fay M, et al. Short-course radiation plus temozolomide in elderly patients with glioblastoma. Engl J Med. 2017;376(11):1027–37. https://doi.org/10.1056/NEJMoa1611977.

    Article  CAS  Google Scholar 

  10. Buckner JC, Shaw EG, Pugh SL, Chakravarti A, Gilbert MR, Barger GR, Coons S, et al. Radiation plus procarbazine, CCNU, and vincristine in low-grade glioma. N Engl J Med. 2016;374(14):1344–55. https://doi.org/10.1056/NEJMoa1500925.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Rogers TW, Toor G, Drummond K, Love C, Field K, Asher R, Tsui A, et al. The 2016 revision of the WHO classification of central nervous system tumours: retrospective application to a cohort of diffuse gliomas. J Neurooncol. 2017; https://doi.org/10.1007/s11060-017-2710-7.

    Article  Google Scholar 

  12. van den Bent MJ, Baumert B, Erridge SC, Vogelbaum MA, Nowak AK, Sanson M, Brandes AA, et al. Interim results from the CATNON trial (EORTC study 26053–22054) of treatment with concurrent and adjuvant temozolomide for 1p/19q non-co-deleted anaplastic glioma: a phase 3, randomised, open-label intergroup study. Lancet. 2017;390(10103):1645–53. doi: https://doi.org/10.1016/S0140-6736(17)31442-3. Epub 2017 Aug 8.

    Article  CAS  Google Scholar 

  13. Wick W, Hartmann C, Engel C, Stoffels M, Felsberg J, Stockhammer F, Sabel MC, et al. NOA-04 randomized phase III trial of sequential radiochemotherapy of anaplastic glioma with procarbazine, lomustine, and vincristine or temozolomide. J Clin Oncol. 2009;27(35):5874–80. https://doi.org/10.1200/JCO.2009.23.6497.

    Article  CAS  PubMed  Google Scholar 

  14. Hollywood E, Semple D. Nursing strategies for patients on oral chemotherapy. Oncology. 2001;15(1 Suppl 2):37–9.

    CAS  PubMed  Google Scholar 

  15. Bordonaro S, Raiti F, Di Mari A, Lopiano C, Romano F, Pumo V, Giuliano SR, et al. Active home-based cancer treatment. J Multidiscip Healthc. 2012;5:137–43. https://doi.org/10.2147/JMDH.S31494.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Hartigan K. Patient education: the cornerstone of successful oral chemotherapy treatment. Clin J Oncol Nurs. 2003;7(6 Suppl):21–4.

    Article  Google Scholar 

  17. Zwinkels H. The developing role of the neuro-oncology nurse: a Dutch perspective. Br J Neurosci Nurs. 2008;4:390–3.

    Article  Google Scholar 

  18. Zwinkels H, Roon K, Jeurissen FJ, Taphoorn MJ, Hop WC, Vecht CJ. Management of temozolomide toxicity by nurse practitioners in neuro-oncology. Oncol Nurs Forum. 2009;36(2):225–31. https://doi.org/10.1188/09.ONF.225-231.

    Article  PubMed  Google Scholar 

  19. MASCC Oral Agent Teaching Tool. 2009. http://www.mascc.org/MOATT. Accessed 8 Aug 2017.

  20. Bedell CH. A changing paradigm for cancer treatment: the advent of new oral chemotherapy agents. Clin J Oncol Nurs. 2003;7(6 Suppl):5–9.

    Article  Google Scholar 

  21. Noronha V, Berliner N, Ballen KK, Lacy J, Kracher J, Baehring J, Henson JW. Treatment-related myelodysplasia/AML in a patient with a history of breast cancer and an oligodendroglioma treated with temozolomide: case study and review of the literature. Neuro Oncol. 2006;8(3):280–3.

    Article  Google Scholar 

  22. Natelson EA, Pyatt D. Temozolomide-induced myelodysplasia. Adv Hematol. 2010;2010:760402. https://doi.org/10.1155/2010/760402.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Armstrong TS, Cao Y, Scheurer ME, Vera-Bolaños E, Manning R, Okcu MF, Bondy M, et al. Risk analysis of severe myelotoxicity with temozolomide: the effects of clinical and genetic factors. Neuro Oncol. 2009;11(6):825–32. https://doi.org/10.1215/15228517-2008-120.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Gerber DE, Grossman SA, Zeltzman M, Parisi MA, Kleinberg L. The impact of thrombocytopenia from temozolomide and radiation in newly diagnosed adults with high-grade gliomas. Neuro Oncol. 2007;9(1):47–52.

    Article  CAS  Google Scholar 

  25. van den Bent MJ, Carpentier AF, Brandes AA, Sanson M, Taphoorn MJ, Bernsen HJ, Frenay M, et al. Adjuvant procarbazine, lomustine, and vincristine improves progression-free survival but not overall survival in newly diagnosed anaplastic oligodendrogliomas and oligoastrocytomas: a randomized European Organisation for Research and Treatment of Cancer phase III trial. J Clin Oncol. 2006;24(18):2715–22.

    Article  Google Scholar 

  26. Lyman GH, Djulbegovic B. The challenge of systematic reviews of diagnostic and staging studies in cancer. Cancer Treat Rev. 2005;31(8):628–39.

    Article  Google Scholar 

  27. Stupp R, Dietrich PY, Ostermann Kraljevic S, Pica A, Maillard I, Maeder P, Meuli R, et al. Promising survival for patients with newly diagnosed glioblastoma multiforme treated with concomitant radiation plus temozolomide followed by adjuvant temozolomide. J Clin Oncol. 2002;20(5):1375–82.

    Article  CAS  Google Scholar 

  28. Dittus KL, Gramling RE, Ades PA. Exercise interventions for individuals with advanced cancer: a systematic review. Prev Med. 2017;pii:S0091-7435(17)30262-1. https://doi.org/10.1016/j.ypmed.2017.07.015.

    Article  Google Scholar 

  29. Zwinkels H, Dörr J, Kloet F, Taphoorn MJ, Vecht CJ. Pregnancy in women with gliomas: a case-series and review of the literature. J Neurooncol. 2013;115(2):293–301. https://doi.org/10.1007/s11060-013-1229-9.

    Article  PubMed  Google Scholar 

  30. Dohle GR. Male infertility in cancer patients. Int J Urol. 2010;17:327–31.

    Article  Google Scholar 

  31. Naysmith TE, Blake DA, Harvey VJ, Johnson NP. Do men undergoing sterilizing cancer treatments have a fertile future? Hum Reprod. 1998;13(11):3250–5.

    Article  CAS  Google Scholar 

  32. Ducray F, Colin P, Cartalat-Carel S, et al. Management of malignant gliomas diagnosed during pregnancy. Rev Neurol (Paris). 2006;162(3):322–9. (in French)

    Article  CAS  Google Scholar 

  33. McGrane J, Bedford T, Kelly S. Successful pregnancy and delivery after concomitant temozolomide and radiotherapy treatment of glioblastoma multiforme. Clin Oncol (R Coll Radiol). 2012;24(4):311. https://doi.org/10.1016/j.clon.2012.01.005.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Haaglanden Medisch Centrum, Antonius Hove, Leidschendam, The Netherlands

    Hanneke Zwinkels

Authors
  1. Hanneke Zwinkels
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hanneke Zwinkels .

Editor information

Editors and Affiliations

  1. Department of Neurosurgery, Cambridge University Hospitals NHS Foundation, Cambridge, Cambridgeshire, UK

    Ingela Oberg

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Zwinkels, H. (2019). Chemotherapy for Gliomas. In: Oberg, I. (eds) Management of Adult Glioma in Nursing Practice. Springer, Cham. https://doi.org/10.1007/978-3-319-76747-5_15

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-76747-5_15

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-76746-8

  • Online ISBN: 978-3-319-76747-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation