Chemotherapy uses drugs to kill or slow tumor cells, and for gliomas the workhorse drug is temozolomide (often abbreviated TMZ, brand name Temodar). Understanding how it's used can make it feel far less intimidating.
Why temozolomide? Temozolomide is an oral chemotherapy that crosses the blood-brain barrier — the brain's protective filter that blocks many drugs — which is exactly why it's so useful for brain tumors. It works by damaging the DNA of tumor cells so they can't keep dividing. Its effectiveness is influenced by MGMT methylation status (covered in its own article): tumors with the MGMT gene switched off tend to respond better.
How it's taken A major advantage is that temozolomide is a pill taken at home, not an IV infusion. It's typically used in two phases for glioblastoma:
- During radiation: a lower daily dose taken every day alongside radiation.
- After radiation (adjuvant): higher doses taken for several days in a row, in cycles repeated about every four weeks, often for around six cycles (sometimes more, depending on your team's plan).
What to expect Temozolomide is generally better tolerated than many chemotherapies, but it does have side effects — nausea (usually controllable with anti-nausea medication taken beforehand), fatigue, and effects on blood counts (which is why you'll have regular blood tests). Because it can lower certain immune cells, doctors often prescribe a preventive antibiotic during the radiation phase. Detailed side-effect management has its own article.
Other chemotherapy While temozolomide is most common, other regimens exist for specific situations — for example, the PCV combination (procarbazine, lomustine/CCNU, and vincristine) is used for certain oligodendrogliomas and other gliomas, and lomustine may be used for some recurrences. Your oncologist chooses based on your tumor type, molecular markers, and prior treatment.
A practical note: taking chemo at home gives you flexibility but also responsibility. Follow the timing and food instructions, keep anti-nausea medication on hand, attend blood-count checks, and report fevers or significant symptoms promptly.