Dexamethasone in Neuro-oncology: Clinical Applications, Pharmacokinetics, and Future Directions

Introduction: Dexamethasone is widely utilized in neuro-oncology, primarily for managing cerebral edema associated with brain tumors. While it effectively reduces inflammation and intracranial pressure, its immunosuppressive properties may interfere with concurrent therapies for glioblastoma (GBM). This review explores the pharmacokinetics, clinical applications, and challenges of dexamethasone use in neuro-oncology, emphasizing the need for a balance between therapeutic benefits and potential risks.

Methods: This review synthesizes current literature on the pharmacological profile of dexamethasone, focusing on its mechanisms of action, effects on cerebral edema, and interactions with treatments for GBM. Key studies were analyzed to assess the clinical efficacy of dexamethasone, its side effects, and alternative therapeutic strategies. Emphasis was placed on recent advancements in GBM treatment and the implications for dexamethasone dosing.

Results: Dexamethasone significantly mitigates cerebral edema by stabilizing the blood-brain barrier (BBB) and reducing vascular permeability, enhancing patient outcomes in neuro-oncology. Its pharmacokinetic profile, with high bioavailability (~81%) and effective BBB penetration, supports its versatility in both oral (4–16 mg/day) and intravenous forms. Studies highlight the efficacy of lower dosing regimens, with doses ≤4.1 mg/day linked to improved survival and immune preservation in GBM, reducing the need for high-dose administration that increases risk of severe side effects, including hyperglycemia and immunosuppression. These adverse effects can interfere with treatments such as temozolomide and Tumor Treating Fields, which rely on intact immune function. Findings indicate that tailored dosing and close monitoring could enhance therapeutic efficacy and minimize risks associated with long-term steroid use.

Conclusion : Dexamethasone remains a critical component in the management of cerebral edema in neuro-oncology. Nonetheless, its use requires careful consideration of dosing strategies to mitigate adverse effects while maintaining therapeutic efficacy. Ongoing research into alternative treatments and personalized medicine approaches aims to improve outcomes for patients with GBM, highlighting the need for a nuanced understanding of dexamethasone’s role in conjunction with emerging therapies.