Short review of SEC, a potential dexamethasone-sparing regimen for glioblastoma: Spironolactone, ecallantide, clotrimazole

Kast, Richard E.; Burns, Terence; Halatsch, Marc‐Eric

doi:10.1016/j.neuchi.2020.12.008

Cited by 5 publications

(3 citation statements)

References 102 publications

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“…Our analysis confirmed this trend for younger IDHwt GBM patients but not for older adults with GBM. This age-stratified effect showing an improved hazard for older GBM patients with ACE-I prescription may be related to the ACE-I- and diuretic-mediated reduction of cerebral edema ( Meinig et al, 1980 ; Kast et al, 2021 ; Esquenazi et al, 2017 ) without the substantial side effect profiles of steroids or other forms of therapy with a similar objective to reduce intracranial swelling. ACE-Is are cardio and renal protective with known angiotensin receptor expression by glioma cells ( Happold et al, 2018 ; Weder, 1990 ).…”

Section: Discussionmentioning

confidence: 99%

Age-stratified comorbid and pharmacologic analysis of patients with glioblastoma

Rabin,

Huang,

Kim

et al. 2024

Brain, Behavior, & Immunity - Health

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Section: Discussionmentioning

confidence: 99%

Age-stratified comorbid and pharmacologic analysis of patients with glioblastoma

Rabin,

Huang,

Kim

et al. 2024

Brain, Behavior, & Immunity - Health

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“…Headaches and nausea may be treated with analgesics and antiemetics. Several non-steroidal drugs and drug combinations are also being investigated as possible edema-reducing, glucocorticoid-sparing agents, such as bevacizumab [59] and a combination of spironolactone, ecallantide, and clotrimazole [60]. However, one should consider that the use of drugs like bevacizumab is constrained due to potential complications related to wound healing.…”

Section: Discussionmentioning

confidence: 99%

Dexamethasone in Patients with Glioblastoma: A Systematic Review and Meta-Analysis

Scheffler,

Fung,

Momjian

et al. 2024

Cancers

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Objective: Glioblastomas are the most common primary central nervous system (CNS) tumors. Although modern management strategies have modestly improved overall survival, the prognosis remains dismal, with treatment side effects often impinging on the clinical course. Glioblastomas cause neurological dysfunction by infiltrating CNS tissue and via perifocal oedema formation. The administration of steroids such as dexamethasone is thought to alleviate symptoms by reducing oedema. However, despite its widespread use, the evidence for the administration of dexamethasone is limited and conflicting. Therefore, we aimed to review the current evidence concerning the use and outcomes of dexamethasone in patients with glioblastoma. Methods: We performed a systematic review and meta-analysis according to the PRISMA-P guidelines. We performed a restricted search using the keywords “Dexamethasone” and “Glioblastoma” on PubMed, Web of Science, Cochrane Library, and Academic Search Premier. We included studies reporting on overall survival (OS) and progression-free survival (PFS) in glioblastoma patients receiving higher or lower dexamethasone doses. The risk of bias was assessed using ROBINS-I. We performed a meta-analysis using a random effects model for OS and PFS. Results: Twenty-two retrospective studies were included. Higher doses of dexamethasone were associated with poorer OS (hazard ratio 1.62, confidence interval 1.40–1.88) and PFS (1.49, 1.23–1.81). OS remained worse even when studies corrected for clinical status (1.52, 1.38–1.67). Conclusion: Despite the widespread use of dexamethasone in glioblastoma patients, its use is correlated with worse long-term outcomes. Consequently, Dexamethasone administration should be restricted to selected symptomatic patients. Future prospective studies are crucial to confirm these findings.

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“…Glycyrrhizin was suggested as an adjuvant therapy for avoiding HT by inhibiting the HMGB1/TLR2 signaling pathway ( Chen et al, 2020 ). Corticosteroids are powerful anti-inflammatory agents and have been considered for use in various neurological conditions, especially in brain tumors, primarily to counteract brain edema and inflammation ( Kast et al, 2021 ). However, the application of corticosteroids in stroke remains a topic of debate due to potential risks and the varied outcomes observed in studies.…”

Section: Inflammatory Markersmentioning

confidence: 99%

Emerging diagnostic markers and therapeutic targets in post-stroke hemorrhagic transformation and brain edema

Yao,

Liu,

et al. 2023

Front. Mol. Neurosci.

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Stroke is a devastating condition that can lead to significant morbidity and mortality. The aftermath of a stroke, particularly hemorrhagic transformation (HT) and brain edema, can significantly impact the prognosis of patients. Early detection and effective management of these complications are crucial for improving outcomes in stroke patients. This review highlights the emerging diagnostic markers and therapeutic targets including claudin, occludin, zonula occluden, s100β, albumin, MMP-9, MMP-2, MMP-12, IL-1β, TNF-α, IL-6, IFN-γ, TGF-β, IL-10, IL-4, IL-13, MCP-1/CCL2, CXCL2, CXCL8, CXCL12, CCL5, CX3CL1, ICAM-1, VCAM-1, P-selectin, E-selectin, PECAM-1/CD31, JAMs, HMGB1, vWF, VEGF, ROS, NAC, and AQP4. The clinical significance and implications of these biomarkers were also discussed.

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Short review of SEC, a potential dexamethasone-sparing regimen for glioblastoma: Spironolactone, ecallantide, clotrimazole

Cited by 5 publications

References 102 publications

Age-stratified comorbid and pharmacologic analysis of patients with glioblastoma

Age-stratified comorbid and pharmacologic analysis of patients with glioblastoma

Dexamethasone in Patients with Glioblastoma: A Systematic Review and Meta-Analysis

Emerging diagnostic markers and therapeutic targets in post-stroke hemorrhagic transformation and brain edema

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