Highlights
- •A reduced steroid requirement in patients taking angiotensin receptor blockers (ARBs) was reported in a retrospective series.
- •This randomised trial was designed to assess if the addition of ARBs (Losartan) to standard of care can reduce steroid requirement in patients with de novo GBM.
- •ARBs did not show any impact on steroid requirements during radiotherapy in this trial. A trend towards reduction of peritumoural oedema on magnetic resonance imaging over time was seen but did not reach statistical significance.
Abstract
Background
Glioblastomas (GBMs) induce a peritumoural vasogenic oedema impairing functional status
and quality of life. Steroids reduce brain tumour–related oedema but are associated
with numerous side-effects. It was reported in a retrospective series that angiotensin
receptor blockers might be associated with reduced peritumoural oedema. The ASTER
study is a randomised, placebo-controlled trial to assess whether or not the addition
of Losartan to standard of care (SOC) can reduce steroid requirement during radiotherapy
(RT) in patients with newly diagnosed GBM.
Patients and methods
Patients with a histologically confirmed GBM after biopsy or partial surgical resection
were randomised between Losartan or placebo in addition to SOC with RT and temozolomide
(TMZ). The primary objective was to investigate the steroid dosage required to control
brain oedema on the last day of RT in each arm. The secondary outcomes were steroids
dosage 1 month after the end of RT, assessment of cerebral oedema on magnetic resonance
imaging, tolerance and survival.
Results
Seventy-five patients were randomly assigned to receive Losartan (37 patients) or
placebo (38 patients). No difference in the steroid dosage required to control brain
oedema on the last day of RT, or one month after completion of RT, was seen between
both arms. The incidence of adverse events was similar in both arms. Median overall
survival was similar in both arms.
Conclusions
Losartan, although well tolerated, does not reduce the steroid requirement in newly
diagnosed GBM patients treated with concomitant RT and TMZ.
Trial registration number NCT01805453 with ClinicalTrials.gov.
Keywords
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Article info
Publication history
Published online: February 01, 2019
Accepted:
December 23,
2018
Received in revised form:
December 18,
2018
Received:
October 26,
2018
Identification
Copyright
© 2019 Elsevier Ltd. All rights reserved.
