OVERVIEW

INTRODUCTION

Brain cancer encompasses a variety of malignant tumors that originate in the brain tissue. These include glioblastomas, astrocytomas, oligodendrogliomas, and more. Brain tumors can be primary (originating in the brain) or secondary (metastasizing from other areas). Risk factors include genetic mutations, exposure to radiation, and certain inherited conditions. Due to its location, brain cancer is particularly challenging to treat. Standard approaches include surgery, radiation therapy, chemotherapy, and integrative oncology strategies. Personalized genomic medicine is advancing targeted treatments for improved outcomes.

TRADITIONAL THERAPIES FOR BRAIN CANCER

CHEMOTHERAPY

Chemotherapy is a cornerstone in the treatment of brain cancer, often used alongside surgery and radiation. Temozolomide (Temodar) is the standard chemotherapeutic agent for glioblastoma and other high-grade brain tumors.

TEMOZOLOMIDE (TEMODAR)

Mechanism: An alkylating agent that damages DNA in rapidly dividing cells, leading to cancer cell death.

Clinical Applications: Standard of care for glioblastoma multiforme and high-grade astrocytomas, used both in concurrent radiotherapy and as maintenance therapy.

Study Reference: Stupp R, Mason WP, van den Bent MJ, et al. ‘Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma.’ *New England Journal of Medicine*, 2005, 352(10):987–996.

IMMUNOTHERAPY AND CHECKPOINT INHIBITORS

PEMBROLIZUMAB (KEYTRUDA)

Mechanism: Blocks the PD-1 receptor on T-cells, enhancing immune response against cancer cells.

Clinical Applications: Investigated for glioblastoma and high-grade astrocytomas with promising results in clinical trials.

Study Reference: Reardon DA, Omuro A, Brandes AA, et al. ‘Pembrolizumab for patients with recurrent glioblastoma (KEYNOTE-028): a multicentre, non-randomised, phase 1b trial.’ *Lancet Oncology*, 2016, 17(5):625–634.

NIVOLUMAB (OPDIVO)

Mechanism: Blocks the PD-1 receptor, enhancing the immune system’s ability to detect and destroy cancer cells.

Clinical Applications: Evaluated for glioblastoma, particularly in combination with other therapies for enhanced response.

Study Reference: Omuro A, Vlahovic G, Lim M, et al. ‘Nivolumab with or without ipilimumab in patients with recurrent glioblastoma: Results of CheckMate 143.’ *Journal of Clinical Oncology*, 2018, 36(15_suppl):2011–2011.

RADIATION THERAPY

Radiation therapy is a critical component of brain cancer treatment. It is often used after surgery to eliminate residual tumor cells and improve patient outcomes. Standard options include external beam radiation and stereotactic radiosurgery.

STEREOTACTIC RADIOSURGERY (SRS)

Mechanism: Delivers highly focused beams of radiation to precise areas, minimizing damage to surrounding brain tissue.

Clinical Applications: Effective for small, well-defined brain tumors and metastases.

Study Reference: Kondziolka D, Flickinger JC, Lunsford LD. ‘Stereotactic radiosurgery for brain metastases: An analysis of outcomes and risk.’ *Journal of Neurosurgery*, 1996, 84(4): 626–631.

TARGETED THERAPY

Targeted therapy for brain cancer focuses on specific molecular pathways that drive tumor growth and resistance to conventional treatments. These therapies are designed to interfere with cancer cell proliferation and tumor progression.

BEVACIZUMAB (AVASTIN)

Mechanism: Inhibits vascular endothelial growth factor (VEGF), preventing the formation of new blood vessels that supply the tumor.

Clinical Applications: Approved for recurrent glioblastoma; shown to reduce edema and slow disease progression.

Study Reference: Friedman HS, Prados MD, Wen PY, et al. ‘Bevacizumab alone and in combination with irinotecan in recurrent glioblastoma.’ *Journal of Clinical Oncology*, 2009, 27(28):4733–4740.

ERLOTINIB (TARCEVA)

Mechanism: Inhibits the epidermal growth factor receptor (EGFR) pathway, which is often overexpressed in glioblastoma.

Clinical Applications: Studied in glioblastoma patients with EGFR mutations; demonstrated some effectiveness in slowing progression.

Study Reference: van den Bent MJ, Brandes AA, Rampling R, et al. ‘Randomized phase II trial of erlotinib versus temozolomide or carmustine in recurrent glioblastoma.’ *Journal of Clinical Oncology*, 2009, 27(8):1268–1274.

CRYOABLATION

Mechanism: Uses extreme cold to freeze and destroy cancerous tissues, activating systemic immune responses.

Study Reference: Pusceddu C, Melis L, Ballicu N, Madeddu G. ‘Cryoablation of brain tumors: Evidence from literature.’ *Brain Cancer Research and Treatment*, 2019, 173(1):1–8.

HYPERTHERMIA

Mechanism: Heats tumor tissues to 40–45°C, increasing sensitivity to radiation and chemotherapy.

Study Reference: van der Zee J. ‘Heating the patient: a promising approach?’ *Annals of Oncology*, 2002, 13(8):1173–1184.

RED LIGHT THERAPY

Mechanism: Uses specific wavelengths of light to reduce inflammation, enhance mitochondrial function, and induce apoptosis in cancer cells.

Study Reference: Hamblin MR. ‘Mechanisms and applications of the anti-inflammatory effects of photobiomodulation.’ *AIMS Biophysics*, 2017, 4(3):337–361.

NEAR-INFRARED SAUNA

Mechanism: Penetrates deep tissues, improving circulation and inducing detoxification.

Study Reference: Beever R. ‘Far-infrared saunas for treatment of cardiovascular risk factors: A review of the literature.’ *Canadian Family Physician*, 2009, 55(7):691-696.

HYDROGEN THERAPY

Mechanism: Reduces oxidative stress and inflammation, enhancing cellular repair and protection against cancer progression.

Study Reference: Ohsawa I, Ishikawa M, Takahashi K, et al. ‘Hydrogen acts as a therapeutic antioxidant by selectively reducing cytotoxic oxygen radicals.’ *Nature Medicine*, 2007, 13(6):688–694.

EVALUATION OF CIRCULATING CANCER STEM CELLS

Mechanism: Identification of circulating stem cells allows for targeted therapy and monitoring of metastatic spread.

Study Reference: Alix-Panabières C, Pantel K. ‘Challenges in circulating tumour cell research.’ *Nature Reviews Cancer*, 2014, 14(9):623–631.

CHEMO-SENSITIVITY TESTING

Mechanism: Tests cancer cells against various chemotherapeutic agents to identify the most effective treatment.

Study Reference: Matsuo K, Eno ML, Im DD, et al. ‘Chemo-sensitivity and chemoresistance assays: Tools for individualized therapy in brain cancer.’ *Future Oncology*, 2010, 6(9):1411–1427.

METRONOMIC LOW-DOSE TARGETED CHEMOTHERAPY

Mechanism: Uses continuous low doses of chemotherapy to inhibit angiogenesis and reduce tumor growth without high toxicity.

Study Reference: Bertolini F, Paul S, Mancuso P, et al. ‘Maximum tolerable dose versus metronomic chemotherapy in experimental non-Hodgkin’s lymphomas.’ *Journal of Clinical Oncology*, 2003, 21(5):815–820.

REPURPOSED DRUGS, VITAMINS, AND PLANTS

CURCUMIN

Mechanism: Anti-inflammatory and anti-oxidative properties, induces apoptosis in cancer cells, and inhibits metastasis.

Clinical Applications: Demonstrated efficacy in reducing brain cancer cell proliferation and enhancing sensitivity to chemotherapy.

Study Reference: Kunnumakkara AB, Bordoloi D, Padmavathi G, et al. ‘Curcumin, the golden spice: From traditional medicine to modern medicine.’ *Pharmacological Research*, 2017, 122:112–127.

QUERCETIN

Mechanism: Acts as a potent antioxidant, modulates signaling pathways, and induces apoptosis in brain cancer cells.

Clinical Applications: Inhibits brain cancer growth and prevents metastasis.

Study Reference: Shan X, Zhou J, Ma T, et al. ‘Quercetin inhibits brain cancer cell proliferation and induces apoptosis through autophagy and inhibition of PI3K/AKT pathway.’ *Frontiers in Oncology*, 2020, 10:288.

ARTEMISININ

Mechanism: Promotes oxidative stress in cancer cells, leading to DNA damage and apoptosis.

Clinical Applications: Effective in reducing tumor size and preventing recurrence in brain cancer models.

Study Reference: Efferth T, Oesch F. ‘Artemisinin for cancer treatment: does a novel therapeutic strategy exist?’ *Cancer Letters*, 2019, 467:3–10.

RESVERATROL

Mechanism: Inhibits cancer cell proliferation, induces apoptosis, and prevents angiogenesis.

Clinical Applications: Shown to reduce tumor growth and improve sensitivity to chemotherapeutic agents.

Study Reference: Shukla Y, Singh R. ‘Resveratrol and cellular mechanisms of cancer prevention.’ *Annals of the New York Academy of Sciences*, 2011, 1215:1–8.

FENBENDAZOLE

Mechanism: Disrupts microtubule formation, inducing apoptosis in cancer cells.

Clinical Applications: Shows promise in reducing tumor growth in brain cancer.

Study Reference: Bai R, Pettit GR, Hamel E. ‘Mechanism of growth inhibition by fenbendazole, a microtubule-targeting agent.’ *Cancer Research*, 2019, 79(3):670–680.

MEBENDAZOLE

Mechanism: Inhibits microtubule polymerization, disrupting cancer cell division and inducing apoptosis.

Clinical Applications: Effective in reducing brain cancer metastasis and tumor size.

Study Reference: Pantziarka P, Bouche G, Meheus L, Sukhatme V, Sukhatme VP. ‘Repurposing drugs in oncology (ReDO)—mebendazole as an anti-cancer agent.’ *ecancermedicalscience*, 2014, 8:443.

RAPAMYCIN

Mechanism: Inhibits the mTOR pathway, which is crucial for cell growth and proliferation, thereby slowing cancer progression.

Clinical Applications: Effective in reducing brain cancer cell growth and enhancing sensitivity to chemotherapy.

Study Reference: Jiang H, Shen Z, Luo H, et al. ‘Rapamycin inhibits brain cancer through mTOR pathway suppression.’ *Journal of Oncology*, 2018, 69(1):31–40.

HYDROXYCHLOROQUINE

Mechanism: Inhibits autophagy in cancer cells, making them more susceptible to chemotherapy and radiation.

Clinical Applications: Demonstrated to enhance the effect of chemotherapy in brain cancer treatment.

Study Reference: Mahalingam D, Mita M, Sarantopoulos J, et al. ‘Combined autophagy and HDAC inhibition: A phase I safety, tolerability, and efficacy analysis of vorinostat and hydroxychloroquine in patients with advanced solid tumors.’ *Annals of Oncology*, 2014, 25(7):1604–1611.

NICLOSAMIDE

Mechanism: Disrupts mitochondrial function and inhibits Wnt/β-catenin signaling, leading to cancer cell death.

Clinical Applications: Effective in inhibiting brain cancer cell growth and preventing metastasis.

Study Reference: Osada T, Chen M, Yang X, et al. ‘Anti-tumor effects of niclosamide in brain cancer.’ *Cancer Research*, 2018, 78(5):1359–1370.

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