Perioperative Management of Targeted and Immunologic Agents in Neurosurgical Oncology.

In 30 seconds

This systematic review examined perioperative risks and management of targeted and biologic cancer therapies in patients undergoing neurosurgical procedures, drawing on clinical trials, safety data, meta-analyses, and guidelines. It found the greatest wound-healing concerns with anti-VEGF antibodies and mTOR inhibitors, for which the review proposes preoperative holds of ≥4 weeks and ≥1 week, respectively, and postoperative delays of 2 to 4 weeks. Bleeding and infection risks also varied by drug class. Evidence was limited for BRAF/MEK inhibitors and immune checkpoint inhibitors.

Key findings

• Anti-VEGF antibodies and mTOR inhibitors carried the highest wound-healing risk; proposed preoperative holds were ≥4 weeks and ≥1 week, respectively.
• Postoperative delays of 2 to 4 weeks were proposed for anti-VEGF and mTOR agents because of effects on fibroblasts and angiogenesis.
• VEGF receptor-tyrosine kinase and Bruton's tyrosine kinase inhibitors were associated with bleeding risk independent of platelet count; suggested holds were up to 1 week.
• CDK4/6 inhibitors, JAK inhibitors, and biologic immunomodulators may increase postoperative infection risk; suggested interruptions were 2-7 days.

Why it matters

Systemic cancer therapies can affect wound repair, hemostasis, and immune function, creating perioperative risks that differ across drug classes. This review organizes available evidence and expert consensus into a risk-based framework for timing interruptions and resumption. Such structured consideration may help balance surgical safety against maintaining oncologic treatment, while highlighting areas where perioperative evidence remains limited.

What to keep in mind

Recommendations draw on heterogeneous sources, including trials, safety data, meta-analyses, guidelines, and expert consensus; perioperative data were limited for BRAF/MEK inhibitors and immune checkpoint inhibitors.