Corticosteroid use in neuro-oncology: an update

Abstract

Because of the lack of curative approaches for most patients with malignant brain tumors, supportive therapy, which aims at maintaining quality of life and functional independence, has a central role in the treatment of many patients. Steroids are particularly important in the setting of supportive therapy. They are commonly used to treat tumor-associated edema, and their administration is typically associated with rapid symptom relief, such as the resolution of headaches. Besides their antiedema activity, corticosteroids are characterized by their potent antilymphoma properties and their effects against acute or delayed emesis caused by systemic chemotherapy in cancer patients. Accordingly, steroids are among the most frequently used drugs in oncology. These desirable properties of steroids are counterbalanced by cardiovascular, muscular, and psychiatric side effects. On the cellular level, corticosteroids exert various effects that translate into the desired clinical activity, but they also evoke significant toxicity that may outweigh the beneficial effects. The mode of action and the limitations of steroid treatment are summarized in this review article. Interactions between steroids and other drugs must be considered. A particular challenge to the ongoing use of glucocorticoids is that newer therapeutic approaches are being introduced in neuro-oncology for which concomitant steroids are likely to be contraindicated. These include the emergence of various immunotherapeutic approaches including vaccination strategies and treatment with immune checkpoint inhibitors. Since the administration of steroids may interfere with the activity of these novel therapies, an even more critical evaluation of their use will be required.

Managing Disease and Therapy-Related Complications in Patients with Central Nervous System Tumors

“…The length of treatment is dependent on clinical improvement; however, tapering should be attempted as soon as possible. Steroids may be tapered rapidly if treatment is less than 10-14 days but should be slower for any longer treatment course to avoid adrenal insufficiency, which may present as headache, nausea, myalgias, and symptomatic hypotension [5,11].…”

Efficacy of a Second Brain Biopsy for Intracranial Lesions after Initial Negativity

“…Prebiopsy corticosteroid therapy is known to increase apoptosis, 12 13 14 15 16 and it is considered responsible for misdiagnosing primary lymphomas of the central nervous system. 17 18 19 This concept has recently been challenged by study results suggesting that the diagnostic yield for lymphoma patients receiving corticosteroids is comparable to those for biopsies performed without prebiopsy corticosteroid therapy.…”

Leptomeningeal metastases from non-small cell lung cancer: state of the art and recent advances

“…Studies on dosing and tapering of dexamethasone in LM have not been performed thus far, therefore the dose should be tailored to each patient's individual needs. In general, the lowest dose of steroids should be used for the shortest time possible to limit adverse events, such as arterial hypertension, increased risk of fungal infections, osteoporosis, diabetes, myopathy, and psychiatric effects (e.g., insomnia, emotional lability, hypomanic and manic episodes) [142] .…”