A Review of Glioblastoma and Other Primary Brain Malignancies

To the Editor The recent Review about primary brain malignancies in adults recommended that “patients receiving the equivalent of prednisone 20 mg daily for more than a month…should receive prophylaxis for Pneumocystis jirovecii pneumonia.” In Table 1 in the article, the authors listed the 4 recommended P jirovecii pneumonia prophylaxis medications with their doses and highlighted sulfamethoxazole-trimethoprim as the “preferred” agent with the justification that it “reduces incidence of P jirovecii pneumonia in non-HIV immunocompromised individuals from 6.2% to 0.2%.” Although they provided 1 corresponding citation, the reference is a 2014 Cochrane review that included only trials of leukemia, solid organ transplant, and autologous bone marrow transplant and included only 1 sentence that mentioned patients with brain tumors: “Patients receiving corticosteroids for primary or metastatic brain tumours may be at a higher risk warranting prophylaxis.” There is an accompanying citation to a single center’s experience of P jirovecii pneumonia among patients without AIDS from 1963 to 1992, which reported that some patients had solid tumors; brain tumors were not specifically studied, but the article stated: “An emerging group at risk were patients with a primary or secondary brain neoplasm.” A reference was then provided to an earlier article by the same author that calculated a P jirovecii pneumonia incidence rate of 1.3% (8 of 595 patients with brain tumors developed P jirovecii pneumonia).