Eduardo Bruera, MD, FAAHPM

Eduardo Bruera, MD, FAAHPM, Chair of the Department of Palliative, Rehabilitation, and Integrative Medicine at The University of Texas MD Anderson Cancer Center, Houston, explained the rationale behind this treatment approach. “We know that the tumor mass and the tumor function talk to the brain using byproducts, somatic and automatic nerves, and autoimmune response and that this immune response will also prime the autonomic and somatic nerves,” said Dr. Bruera. “Thus, it would make a lot of sense to explore the potential role of corticosteroids in improving some of these mediators while also having some effect on the astrocyte concentration in the brain that will make more cytokines.”

In addition to the traditional indications for corticosteroids, noted Dr. Bruera, there is also clear evidence that corticosteroids help symptom distress. In addition, there is evidence for chemotherapy-induced nausea, fatigue, pain, anorexia, dyspnea, and mechanical bowel obstruction symptom clusters.

“Corticosteroids are an important tool that have reasonably good levels of evidence for many indications, but the side effects, which are more time-related than dose-related, can be quite significant,” Dr. Bruera continued. “The emergence of immunotherapy, which causes many patients to develop side effects, also poses a challenge because many patients are now ineligible to receive this tool that has traditionally been used in the management of these severe symptoms.

“So, there are challenges with the use of corticosteroids in the area of supportive and palliative care. However, there are potentially great advantages that we need to continue to explore,” Dr. Bruera concluded.■

DISCLOSURE: Dr. Bruera has received research funding from Helsinn Healthcare.