title: Avoiding glucocorticoid administration in a neurooncological case.
abstract: Restricting glucocorticoid (GC) use in the treatment of patients with a solid tumor may help improving outcome. Here, we report administration of celecoxib rather than dexamethasone to prevent brain edema in a patient with a cerebellar glioblastoma multiforme WHO grade IV (GBM) upon the patient's request, as well as determining cerebrospinal fluid (CSF) and serum concentrations. CSF concentration (0.04 microM) was 54 times below serum concentration (2.18 microM), or 2500 times below levels inhibiting GBM cells in vitro (100 microM), revealing a blood CSF barrier for celecoxib. The patient did not require dexamethasone for the entire treatment. GC administration hence was avoided successfully in this case. The role of COX-2 inhibitors in treatment of GBM is detailed, leading to the conclusion of a pressing need for a clinical evaluation of non-steroidal COX-2 inhibitors with the ability to penetrate into brain tumors.
authors.affiliation: Division of Radiation Medicine, Paul Scherrer Institut, Switzerland. hanspeter.rutz@psi.ch
authors.forename: Hans Peter
authors.initials: HP
authors.lastname: Rutz
authors.forename: Silvia
authors.initials: S
authors.lastname: Hofer
authors.forename: Pietro E
authors.initials: PE
authors.lastname: Peghini
authors.forename: Ursula
authors.initials: U
authors.lastname: Gutteck-Amsler
authors.forename: Katharina
authors.initials: K
authors.lastname: Rentsch
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Meier-Abt
authors.forename: Urs R
authors.initials: UR
authors.lastname: Meier
authors.forename: René Ludwig
authors.initials: RL
authors.lastname: Bernays
mesh_terms: D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D001812:Blood-Brain Barrier / Q000502:physiology; D000068579:Celecoxib; D002531:Cerebellum / Q000473:pathology; D016861:Cyclooxygenase Inhibitors / Q000097:blood / Q000134:cerebrospinal fluid / Q000627:therapeutic use*; D003606:Dacarbazine / Q000031:analogs & derivatives / Q000627:therapeutic use; D005500:Follow-Up Studies; D005909:Glioblastoma / Q000201:enzymology* / Q000532:radiotherapy*; D005938:Glucocorticoids; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011720:Pyrazoles / Q000097:blood / Q000134:cerebrospinal fluid / Q000627:therapeutic use*; D013449:Sulfonamides / Q000097:blood / Q000134:cerebrospinal fluid / Q000627:therapeutic use*; D000077204:Temozolomide; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018906:Antineoplastic Agents, Alkylating; D016861:Cyclooxygenase Inhibitors; D005938:Glucocorticoids; D011720:Pyrazoles; D013449:Sulfonamides; D003606:Dacarbazine; D000068579:Celecoxib; D000077204:Temozolomide