"Corticosteroids in brain cancer patients: benefits and pitfalls"
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3109638/
Expert Rev Clin Pharmacol. Author manuscript; available in PMC Jan 1, 2012.
Published in final edited form as:
Expert Rev Clin Pharmacol. Mar 2011; 4(2): 233–242.
doi: 10.1586/ecp.11.1
PMCID: PMC3109638
NIHMSID: NIHMS295240
Corticosteroids in brain cancer patients: benefits and pitfalls
Jörg Dietrich,1,2 Krithika Rao,3 Sandra Pastorino,3 and Santosh Kesari3,†
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Abstract
Glucocorticoids have been used for decades in the treatment of brain tumor patients and belong to the most powerful class of agents in reducing tumor-associated edema and minimizing side effects and the risk of encephalopathy in patients undergoing radiation therapy. Unfortunately, corticosteroids are associated with numerous and well-characterized adverse effects, constituting a major challenge in patients requiring long-term application of corticosteroids. Novel anti-angiogenic agents, such as bevacizumab (Avastin®), which have been increasingly used in cancer patients, are associated with significant steroid-sparing effects, allowing neuro-oncologists to reduce the overall use of corticosteroids in patients with progressive malignant brain tumors. Recent experimental studies have revealed novel insights into the mechanisms and effects of corticosteroids in cancer patients, including modulation of tumor biology, angiogenesis and steroid-associated neurotoxicity. This article summarizes current concepts of using corticosteroids in brain cancer patients and highlights potential pitfalls in their effects on both tumor and neural progenitor cells.
Keywords: anti-angiogenesis, brain cancer, cancer stem cells, corticosteroids, dexamethasone, giloma, neural stem cells, neurotoxicity
The possible novel use of VEGF inhibitors instead of steriods and or in addition to for edema in the brain ?
The large number of complications associated with corticosteroid therapy has led to the search for alternative therapies for peritumoral edema. Corticotropin-releasing factor (CRF) [76,77] reduces peritumoral edema by a direct effect on blood vessels through CRF 1 and 2 receptors, independent of the release of adrenal steroids, and has been effective in animal models [76]. Phase I/II trials of this agent suggested that it is relatively well tolerated [77,78]. Several Phase III trials are currently in progress examining the efficacy of this drug in the treatment of acute and chronic peritumoral edema. Recently, preliminary studies suggest that cyclooxygenase-2 inhibitors might be effective in treating cerebral edema [79,80]. Clinical studies using cyclooxygenase-2 inhibitors for peritumoral edema are planned, although the cardiac complications of this class of drugs have delayed these studies. Since VEGF plays an important role in the pathogenesis of peritumoral edema, it is possible that inhibitors of VEGF, such as VEGF antibodies (e.g., bevacizumab [Avastin®]) or inhibitors of VEGF receptors, such as cediranib (Recentin™), sorafenib (Nexavar®) and sunitinib (Sutent®) may be helpful in reducing peritumoral edema (Table 1) [81]. It is hoped that some of these agents will prove to be more effective and less toxic alternatives to corticosteroids [82].
Table 1
Table 1
Novel angiogenesis inhibitors associated with steroid-sparing effects.