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Erschienen in: Journal of Neuro-Oncology 1/2010

01.05.2010 | Clinical Study - Patient Study

Antiepileptics in brain metastases: safety, efficacy and impact on life expectancy

verfasst von: M. Maschio, L. Dinapoli, S. Gomellini, V. Ferraresi, F. Sperati, A. Vidiri, P. Muti, B. Jandolo

Erschienen in: Journal of Neuro-Oncology | Ausgabe 1/2010

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Abstract

The aim of the study was to evaluate efficacy, safety and impact on life expectancy of levetiracetam (LEV), oxcarbazepine (OXC) and topiramate (TPM) monotherapy in patients with seizures related to brain metastases. We conducted a prospective observational study on 70 patients with brain metastases. Thirteen patients were excluded because they were in prophylactic therapy with antiepileptics, nine patients did not return to our Center. A total of 48 patients with epilepsy related to brain metastases were enrolled. Patients were treated with LEV, OXC and TPM in monotherapy and followed until their death. Eighteen patients dropped out. Therefore, we followed 30 patients. Mean duration of follow-up was 6.1 months. Upon visiting the patients prior to their death (i.e. last visit preceding the death of the patients), we observed a significant reduction (P < 0.001) in the mean monthly seizure frequency; with 19 patients (63.3%) obtaining complete seizure control in the whole population. A significant improvement of seizure frequency was also observed considering each antiepileptic treatment group separately. Median survival time was similar among the three groups of patients and was similar to Class I of prognostic factors of Radiation Therapy Oncology Group. Logistic regression showed that systemic treatments did not influence the antiepileptics’ efficacy on seizure control (P = 0.614). In conclusion, regarding the use of newer antiepileptics in patients with seizures related to brain metastases, our data indicate that LEV, OXC and TPM significantly reduce seizure frequency (independently of systemic treatment), produce few side effects and appear not to affect life expectancy.
Literatur
1.
Zurück zum Zitat Van den Bent MJ (2003) The role of chemotherapy in brain metastases. Eur J Cancer 39:2114–2120CrossRefPubMed Van den Bent MJ (2003) The role of chemotherapy in brain metastases. Eur J Cancer 39:2114–2120CrossRefPubMed
2.
Zurück zum Zitat Taillibert S, Delattre JY (2005) Metastatic tumors of the nervous system. J Neurooncol 75:1–3CrossRefPubMed Taillibert S, Delattre JY (2005) Metastatic tumors of the nervous system. J Neurooncol 75:1–3CrossRefPubMed
3.
Zurück zum Zitat Soffietti R, Cornu P, Delattre JY et al (2006) EFNS. Guidelines on diagnosis and treatment of brain metastases: report of an EFNS Task Force. Eur J Neurol 3:674–681CrossRef Soffietti R, Cornu P, Delattre JY et al (2006) EFNS. Guidelines on diagnosis and treatment of brain metastases: report of an EFNS Task Force. Eur J Neurol 3:674–681CrossRef
4.
Zurück zum Zitat Kaal EC, Taphoorn MJ, Vecht CJ (2005) Symptomatic management and imaging of brain metastases. J Neurooncol 75:15–20CrossRefPubMed Kaal EC, Taphoorn MJ, Vecht CJ (2005) Symptomatic management and imaging of brain metastases. J Neurooncol 75:15–20CrossRefPubMed
5.
6.
Zurück zum Zitat Lim LC, Rosenthal MA, Maartens N, Ryan G (2004) Management of brain metastases. Intern Med J 34:270–278CrossRefPubMed Lim LC, Rosenthal MA, Maartens N, Ryan G (2004) Management of brain metastases. Intern Med J 34:270–278CrossRefPubMed
7.
Zurück zum Zitat Khuntia D, Braun P, Li J, Mehta MP (2006) Whole-brain radiotherapy in the management of brain metastasis. J Clin Oncol 24:1295–1304CrossRefPubMed Khuntia D, Braun P, Li J, Mehta MP (2006) Whole-brain radiotherapy in the management of brain metastasis. J Clin Oncol 24:1295–1304CrossRefPubMed
8.
Zurück zum Zitat Ewend MG, Elbabaa S, Carey LA (2005) Current treatment paradigms for the management of patients with brain metastases. Neurosurgery 57(Suppl 5):66–77 (discussion 1–4) Ewend MG, Elbabaa S, Carey LA (2005) Current treatment paradigms for the management of patients with brain metastases. Neurosurgery 57(Suppl 5):66–77 (discussion 1–4)
9.
Zurück zum Zitat Davey P (2002) Brain metastases: treatment options to improve outcomes. CNS Drugs 16:325–338CrossRefPubMed Davey P (2002) Brain metastases: treatment options to improve outcomes. CNS Drugs 16:325–338CrossRefPubMed
11.
Zurück zum Zitat Wen PY, Marks PW (2002) Medical management of patients with brain tumors. Curr Opin Oncol 14:299–307CrossRefPubMed Wen PY, Marks PW (2002) Medical management of patients with brain tumors. Curr Opin Oncol 14:299–307CrossRefPubMed
12.
Zurück zum Zitat Glantz MJ, Cole BF, Forsyth PA et al (2000) Practice parameter: anticonvulsant prophylaxis in patients with newly diagnosed brain tumors. Neurology 54:1886–1893PubMed Glantz MJ, Cole BF, Forsyth PA et al (2000) Practice parameter: anticonvulsant prophylaxis in patients with newly diagnosed brain tumors. Neurology 54:1886–1893PubMed
13.
Zurück zum Zitat Vecht CJ, Wagner GL, Wilms EB (2003) Treating seizures in patients with brain tumors: drug interactions between antiepileptic and chemotherapeutic agents. Semin Oncol 30:49–52CrossRefPubMed Vecht CJ, Wagner GL, Wilms EB (2003) Treating seizures in patients with brain tumors: drug interactions between antiepileptic and chemotherapeutic agents. Semin Oncol 30:49–52CrossRefPubMed
14.
Zurück zum Zitat Vecht CJ, Wagner GL, Wilms EB (2003) Interactions between antiepileptic and chemotherapeutic drugs. Lancet Neurol 2:404–409CrossRefPubMed Vecht CJ, Wagner GL, Wilms EB (2003) Interactions between antiepileptic and chemotherapeutic drugs. Lancet Neurol 2:404–409CrossRefPubMed
15.
Zurück zum Zitat Kaal EC, Niël CG, Vecht CJ (2005) Therapeutic management of brain metastasis. Lancet Neurol 4:289–298CrossRefPubMed Kaal EC, Niël CG, Vecht CJ (2005) Therapeutic management of brain metastasis. Lancet Neurol 4:289–298CrossRefPubMed
16.
Zurück zum Zitat Newton HB, Dalton J, Goldlust S, Pearl D (2007) Retrospective analysis of the efficacy and tolerability of levetiracetam in patients with metastatic brain tumors. J Neurooncol 84:293–296CrossRefPubMed Newton HB, Dalton J, Goldlust S, Pearl D (2007) Retrospective analysis of the efficacy and tolerability of levetiracetam in patients with metastatic brain tumors. J Neurooncol 84:293–296CrossRefPubMed
17.
Zurück zum Zitat Maschio M, Albani F, Jandolo B et al (2008) Temozolomide treatment does not affect topiramate and oxcarbazepine plasma concentrations in chronically treated patients with brain tumor-related epilepsy. J Neurooncol 90:217–221CrossRefPubMed Maschio M, Albani F, Jandolo B et al (2008) Temozolomide treatment does not affect topiramate and oxcarbazepine plasma concentrations in chronically treated patients with brain tumor-related epilepsy. J Neurooncol 90:217–221CrossRefPubMed
18.
Zurück zum Zitat Contin M, Albani F, Riva R, Baruzzi A (2004) Levetiracetam therapeutic monitoring in patients with epilepsy: effect of concomitant antiepileptic drugs. Therap Drug Monitor 26:375–379CrossRef Contin M, Albani F, Riva R, Baruzzi A (2004) Levetiracetam therapeutic monitoring in patients with epilepsy: effect of concomitant antiepileptic drugs. Therap Drug Monitor 26:375–379CrossRef
19.
Zurück zum Zitat Oberdorfer S, Piribauer M, Marosi C et al (2005) P450 enzymes inducing and non-enzyme inducing antiepileptics in glioblastoma patients treated with standard chemotherapy. J Neurooncol 272:255–260CrossRef Oberdorfer S, Piribauer M, Marosi C et al (2005) P450 enzymes inducing and non-enzyme inducing antiepileptics in glioblastoma patients treated with standard chemotherapy. J Neurooncol 272:255–260CrossRef
20.
Zurück zum Zitat Cloughesy TF, Wen PY, Robins I et al (2006) Phase II trial of tipifarnib in patients with recurrent malignant glioma either receiving or not receiving enzyme-inducing antiepileptic drugs: a North American brain tumor consortium study. J Clin Oncol 24:3651–3656CrossRefPubMed Cloughesy TF, Wen PY, Robins I et al (2006) Phase II trial of tipifarnib in patients with recurrent malignant glioma either receiving or not receiving enzyme-inducing antiepileptic drugs: a North American brain tumor consortium study. J Clin Oncol 24:3651–3656CrossRefPubMed
22.
Zurück zum Zitat Gaspar L, Scott C, Rotman M et al (1997) Recursive partitioning analysis (RPA) of prognostic factors in three radiation therapy oncology groups (RTOG). Brain metastases trials. Int J Radiat Oncol 37:745–751CrossRef Gaspar L, Scott C, Rotman M et al (1997) Recursive partitioning analysis (RPA) of prognostic factors in three radiation therapy oncology groups (RTOG). Brain metastases trials. Int J Radiat Oncol 37:745–751CrossRef
23.
Zurück zum Zitat Brada M, Viviers L, Abson C et al (2003) Phase II study of primary temozolomide chemotherapy in patients with WHO grade II gliomas. Ann Oncol 14:1715–1721CrossRefPubMed Brada M, Viviers L, Abson C et al (2003) Phase II study of primary temozolomide chemotherapy in patients with WHO grade II gliomas. Ann Oncol 14:1715–1721CrossRefPubMed
24.
Zurück zum Zitat van Breemen MS, Rijsman RM, Taphoorn MJ, Walchenbach R, Zwinkels H, Vecht CJ (2009) Efficacy of anti-epileptic drugs in patients with gliomas and seizures. J Neurol 256:1519–1526CrossRefPubMed van Breemen MS, Rijsman RM, Taphoorn MJ, Walchenbach R, Zwinkels H, Vecht CJ (2009) Efficacy of anti-epileptic drugs in patients with gliomas and seizures. J Neurol 256:1519–1526CrossRefPubMed
Metadaten
Titel
Antiepileptics in brain metastases: safety, efficacy and impact on life expectancy
verfasst von
M. Maschio
L. Dinapoli
S. Gomellini
V. Ferraresi
F. Sperati
A. Vidiri
P. Muti
B. Jandolo
Publikationsdatum
01.05.2010
Verlag
Springer US
Erschienen in
Journal of Neuro-Oncology / Ausgabe 1/2010
Print ISSN: 0167-594X
Elektronische ISSN: 1573-7373
DOI
https://doi.org/10.1007/s11060-009-0069-0

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