Wednesday, 30 March 2016

Corticosteroids (eg dexamethasone) and survival in GBM

Click here to view abstract

This study includes such names as Roger Stupp and Michael Weller on the author list, so cannot be taken lightly.

This paper consists of a retrospective human study and a mouse study.  The mouse study shows an antagonistic effect of dexamethasone on the efficacy of radiation (mouse survival was shorter when given dexamethasone with radiation compared to radiation alone).   An anti-VEGF antibody (similar to Avastin) was used in another group mice as an alternative means of edema control, and no interference with radiation was observed.

"Beyond the established adverse effect profile of protracted corticosteroid use, this analysis substantiates the request for prudent and restricted use of corticosteroids in glioblastoma."
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5 comments:

  1. Logan Lo31 March 2016 at 08:11

    I know that you had previously suggested the WokVel Boswellia - was there ever a determination as to dosage for a replacement of 4mg of Dexa? And does weight come into play as my wife is currently less than 80 pounds.

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    1. Stephen W31 March 2016 at 17:28

      If a patient has significant edema I'm not sure that dex could be replaced by Boswellia, but it could help to reduce the dex dose. Not everyone needs steroids during radiotherapy, but some people will. The goal should be to use the lowest effective dose (or none if none is required), and taking supplements like Boswellia should help to lower that dose. In past trials with Boswellia, high doses were required to see any steroid-lowering effect. Wokvel Boswellia uses the same Solid Lipid particle technology as used in Longvida (and is made by the same company, Verdure Sciences). Recommended dose is 333-999mg daily (each capsule is 333 mg). So I would use 3 capsules daily as baseline, and perhaps increase from there.

      https://www.pureformulas.com/boswellia-serrata-extract-wokvel-180-capsules-by-progena.html

      http://www.wokvel.com/about.html

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    2. Logan Lo1 April 2016 at 05:43

      Great - I just purchased a bottle of that and will be trying to utilize that for the edema.

      Delete
  2. SVG31 March 2016 at 14:07

    Corticosteroids should be avoided as much as possible an any case ! However, inflammation should be avoided as well, and radiotherapy induces inflammation. That is the "impossible balance".

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