Optimal Management of Corticosteroids in Patients with Intracranial Malignancies
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Neuro-oncology (GJ Lesser, Section Editor)
Optimal Management of Corticosteroids in Patients with Intracranial Malignancies Karan S. Dixit, MD Priya U. Kumthekar, MD* Address * Department of Neurology, Division of Neuro-Oncology, Northwestern University Feinberg School of Medicine, Chicago, USA Email: [email protected]
* Springer Science+Business Media, LLC, part of Springer Nature 2020
This article is part of the Topical Collection on Neuro-oncology Keywords Corticosteroids I Glioma I Brain metastases I Immunotherapy I Immunosuppression I Myopathy I Quality of life
Opinion statement Corticosteroids have been essential in the management of brain tumor patients for decades, primarily for the treatment of peritumoral cerebral edema and its associated neurologic deficits. Dexamethasone is the drug of choice with standard practice being administration up to four times per day, however, because of its long biologic half-life and high potency, once or twice a day dosing is likely adequate in patients without elevated intracranial pressure. The length of corticosteroid treatment should be limited to the shortest period of time to minimize the risk of potential toxicities that can significantly affect quality of life, as well as to avoid a possible detrimental impact on survival in highgrade glioma patients and abrogation of the effect of immunotherapy. Agents such as bevacizumab should be considered in patients who are unable to wean completely off of steroids as well as those who have symptomatic edema and are on immunotherapy. Several other agents have been studied without much success. An increased understanding of the complex pathophysiology of peritumoral vasogenic edema is critically needed to discover new agents that are safer and more effective.
Introduction Corticosteroids have widely been used for patients with brain cancer since the 1950s; when it was discovered, they alleviate vasogenic edema in patients with brain
metastases. Corticosteroids, specifically dexamethasone, have since become the gold standard for management of peritumoral cerebral edema and its associated
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neurologic symptoms [1, 2]. Although corticosteroids provide significant clinical benefit to patients, they are associated with numerous potential side effects, especially with prolonged use [3]. There is also mounting evidence suggesting a negative impact on survival in glioma patients treated with corticosteroids. Thus,
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judicious use of corticosteroids is needed to minimize undesirable effects. In this review, we will summarize the pharmacology, toxicity profile, and optimal use and dosing strategies for corticosteroids, with an emphasis on dexamethasone.
Pharmacology and mechanism of action Corticosteroids, which consist of both glucocorticoids and mineralocorticoids, are hormones released by the adrenal cortex and mediate critical physiologic functions including stress response, inflammation, metabolism, and homeostasis [4]. They exert their effects by binding to
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