Roth Patrick, Happold Caroline, Weller Michael
Department of Neurology and Brain Tumor Center , University Hospital Zurich , Switzerland.
Neurooncol Pract. 2015 Mar;2(1):6-12. doi: 10.1093/nop/npu029. Epub 2014 Oct 9.
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.
由于大多数恶性脑肿瘤患者缺乏治愈性方法，旨在维持生活质量和功能独立性的支持性治疗在许多患者的治疗中起着核心作用。类固醇在支持性治疗中尤为重要。它们通常用于治疗肿瘤相关水肿，其使用通常会带来症状的迅速缓解，如头痛的缓解。除了其抗水肿活性外，皮质类固醇还具有强大的抗淋巴瘤特性以及对癌症患者全身化疗引起的急性或迟发性呕吐的作用。因此，类固醇是肿瘤学中最常用的药物之一。类固醇的这些理想特性被心血管、肌肉和精神方面的副作用所抵消。在细胞水平上，皮质类固醇发挥着各种作用，这些作用转化为预期的临床活性，但它们也会引发显著的毒性，这种毒性可能超过有益效果。本文综述了类固醇治疗的作用方式和局限性。必须考虑类固醇与其他药物之间的相互作用。持续使用糖皮质激素面临的一个特殊挑战是，神经肿瘤学中正在引入新的治疗方法，而同时使用类固醇可能是禁忌的。这些方法包括各种免疫治疗方法的出现，包括疫苗接种策略和免疫检查点抑制剂治疗。由于类固醇的使用可能会干扰这些新疗法的活性，因此需要对其使用进行更严格的评估。
