Section 14
Neuro-Oncology
Brain Tumor & Edema Therapies
5 AGENTS
Dexamethasone
DecadronCorticosteroid
- Forms
- Tab: 0.5, 0.75, 1, 1.5, 2, 4, 6mg | IV: 4, 10mg/mL
- Dose
- Vasogenic edema: 10mg IV load, then 4mg q6h (range 4-16mg/day divided)
- MOA
- Reduces vasogenic edema and inflammation
Temozolomide
TemodarAlkylating agent
- Forms
- Cap: 5, 20, 100, 140, 180, 250mg | IV: 100mg vial
- Dose
- Glioblastoma: 75mg/m² daily with radiation (42-49 days), then 150-200mg/m² days 1-5 of 28-day cycles
- MOA
- DNA methylation causing tumor cell death
Bevacizumab
AvastinAnti-VEGF mAb
- Forms
- IV: 100mg/4mL, 400mg/16mL
- Dose
- Recurrent glioblastoma: 10mg/kg IV every 2 weeks
- MOA
- Neutralizes VEGF-A, ↓angiogenesis and vasogenic edema
Lomustine
GleostineNitrosourea alkylator
- Forms
- Cap: 5, 40, 100mg
- Dose
- 130mg/m² single oral dose every 6 weeks (reduce if marrow compromised)
- MOA
- Crosslinks DNA/RNA; crosses blood-brain barrier
Vorasidenib
VoranigoIDH1/IDH2 inhibitor
- Forms
- Tab: 10, 40mg
- Dose
- Adults: 40mg once daily | Age 12+: 40mg (40kg or more) or 20mg (under 40kg) once daily; Grade 2 IDH1/2-mutant glioma
- MOA
- Blocks mutant IDH enzymes, ↓2-HG production