Antisecretory factor for treatment of peritumoral edema in glioblastoma patients.

Purpose: Glioblastoma (GBM) is an aggressive brain tumor often accompanied by a vasogenic peritumoral edema, which contributes to symptoms both at diagnosis and during later stages of the disease. Previous studies have suggested effectiveness of the endogenous protein, Antisecretory Factor (AF), in reducing the intracranial pressure in cytotoxic brain edema after trauma. Interestingly, AF also seems to carry antineoplastic effects in experimental GBM models. This study investigated whether AF reduces peritumoral edema in GBM patients. As a secondary aim, we assessed potential effects on tumor progression by AF.

Methods: Fifteen newly diagnosed GBM patients were treated for 7 days preoperatively with AF in addition to standard of care (SOC) treatment with corticosteroids. The change in edema volume was assessed volumetrically using T2/FLAIR weighted MRI and compared to a control group of 10 GBM patients receiving SOC only.

Results: At baseline the mean tumor volume for the entire cohort was 35.7 cm3 with a mean edema of 62.2 cm3. There was no significant difference in edema volume change between the AF treated patients, who demonstrated a mean edema reduction of 7.1cm3 (95%CI -5.4-19.6), and the controls, 11.3cm3 (95%CI -0.8-23.5), p = 0.61. No difference was observed in tumor volume change between the two groups, p = 0.79. No adverse treatment effects were noted.

Conclusion: Treatment with AF in addition to SOC does not seem to reduce the peritumoral edema in GBM patients. The treatment was well tolerated. The lack of edema-reducing effect may be related to the different pathophysiological properties of vasogenic and cytotoxic edema.