Neurological and vascular complications of primary and secondary brain tumours: EANO-ESMO Clinical Practice Guidelines for prophylaxis, diagnosis, treatment and follow-up

Abstract

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Glioblastoma: clinical presentation, diagnosis, and management

“…Antiepileptic drugs are recommended for patients who have had a seizure, but there is no good quality evidence to support their prophylactic use 11294950. National clinical guidelines recommend choice of formulation based on various factors, including age and seizure type 3251.…”

“…National clinical guidelines recommend choice of formulation based on various factors, including age and seizure type 3251. Non-enzyme inducing antiepileptic drugs (such as levetiracetam, lamotrigine) are preferred to avoid interactions with chemotherapy and corticosteroids 50. Some antiepileptic drugs may lack efficacy in patients with glioblastoma due to loss of receptor sensitivity or expression of multidrug resistance proteins, which can result in refractory epilepsy 5152.…”

“…Some antiepileptic drugs may lack efficacy in patients with glioblastoma due to loss of receptor sensitivity or expression of multidrug resistance proteins, which can result in refractory epilepsy 5152. Levetiracetam is often the first drug of choice in most neuro-oncology centres since it is usually well tolerated, can be initiated orally at a therapeutic dose, does not require monitoring, and is not thought to be affected by multidrug resistance proteins 23505152. There is no consensus regarding the optimal duration of therapy in glioblastoma patients, and many clinicians therefore opt to continue antiepileptic drugs indefinitely if they are well tolerated 53.…”

Neurological complications of cancer immunotherapy

“…Questions have been raised if ICI may be associated with an increased risk of complications in the CNS in patients suffering from a brain tumor. Accordingly, and similar to the development of many other drugs, patients with primary or secondary brain tumors were not eligible in early trials exploring the activity of ICI because of the fear that these patients may be more prone to neurological complications [55]. In the meantime, both CTLA-4 and mainly PD-1 inhibitors were assessed in patients with brain metastases as well as primary brain tumors such as glioblastoma.…”

The Value of Anlotinib in the Treatment of Intractable Brain Edema: Two Case Reports

“…Blocking the VEGF pathway can decrease vascular permeability and, thus, cerebral edema ( 7 ). Although glucocorticoids are traditionally used for the treatment of intractable brain edema, they have multiple side effects, relatively poor safety and efficacy, and are unable to inhibit the progression of brain tumors ( 19 ). In addition, with the introduction of immune-checkpoint inhibitors (including PD-1/PD-L1 and CTLA-4) in clinical practice, the research of alternatives to steroids remains a critical issue.…”