High Doses of Dexamethasone May Reduce Survival of Recurrent Glioblastoma Patients

Dr. Eric T. Wong, MD, from the Brain Tumor Center and Neuro-Oncology Unit, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston and colleagues, reported that high doses of dexamethasone given to recurrent glioblastoma patients may actually decrease their survival through immunosuppression. This study was recently published in British Journal of Cancer.

Dr. Eric T. Wong and colleagues decided to carry out their study on the effects of dexamethasone on glioblastoma through data analysis of patients who were involved in the phase 3 registration trial of a tool that radiates tumor treating fields (TTFields) to the tumor and its adjacent structures. The tool, NovoTTF-100A, is approved for glioblastoma treatment. NovoTTF-100A disrupts the mitotic division of proliferating cells leading to cell death. Patients in the registration trials were treated either with chemotherapy or with NovoTTF-100A. Dr. Eric T. Wong and colleagues did a retrospective analysis on the effects of dexamethasone on the group of patients that received chemotherapy and the group of patients that were treated with NovoTTF-100A.

Retrospective analysis of the NovoTTF-100A cohort revealed that 64 patients who were given high-dose dexamethasone (more than 4.1 mg per day) had shorter median survival than the 56 patients who were given low-dose dexamethasone. Comparatively, retrospective analysis of the chemotherapy cohort showed similar but less devastating median survival. In the chemotherapy cohort, 54 patients who were given high-dose dexamethasone had a shorter median survival than the 63 patients who were given low-dose dexamethasone. Further details on the study result can be found here.

Dr. Mark Gilbert, MD, Senior Investigator and Chief of Neuro-Oncology at the National Cancer Institute in Bethesda, Maryland, uninvolved in this study said that the hypothesis on high-dose dexamethasone affecting the survival of recurrent glioblastoma patients is interesting. However, he was concerned that the investigators did not factor in other prognostic factors that may require the use of high-dose dexamethasone. The dose of dexamethasone used currently is not controlled by clinical trial protocols and it is based on physicians' practice patterns and choice. Another physician unrelated in this study, Dr. Howard A. Fine, MD, from the Weill Cornell Medical College and the New York Presbyterian Hospital in New York City, agreed that observations of this study must be analyzed carefully taking into account the different clinical management of glioblastoma.


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