Basic principles of brain tumor chemotherapy

Abstract

The use of chemotherapy for brain tumors has been an age-old challenge for Neuro-Oncologists. Brain tumor entities are vast and represent a biologically distinct and heterogenous group of diseases with complex tumor heterogeneity and genomic landscapes that govern growth rates and response to therapy. The presence of the blood-brain barrier is also a major hurdle for effective drug delivery to the tumor niche and has garnered research attention for decades. Despite robust research efforts aimed at developing new agents to treat patients with malignant brain tumors such as glioblastoma, high-grade meningioma, childhood atypical teratoid/rhabdoid tumor, and diffuse intrinsic pontine glioma, survival rates remain low. Yet, with advances in cancer genomics, pharmacogenomics, cancer immunology, and new next-generation therapies are on the horizon and offer a glimmer of hope for an improved patient outcome. In this chapter, we provide a comprehensive, broad overview of chemotherapy in Neuro-Oncology and highlight the major challenges of drug development and emerging strategies to improve the standard of care for patients with brain tumors.