Effect of anti-epileptic drugs on the survival of patients with glioblastoma multiforme: A retrospective, single-center study.

Jae Yeoul Ryu,Min Jung Chang,Kyoung Lok Min,Michael C Burger

doi:10.1371/journal.pone.0225599

Abstract

Glioblastoma multiforme (GBM) is a lethal and aggressive malignant tumor of the central nervous system. The World Health Organization classifies it as a grade IV astrocytoma. Controlling seizures is essential during GBM treatment because they are often present and closely associated with the quality of life of GBM patients. Some antiepileptic drugs (AEDs) exhibit antitumor effects and could decrease the mortality of patients with GBM. In this retrospective cohort study, we examined 418 patients treated with surgery, radiotherapy, and chemotherapy with temozolomide (TMZ) at Severance Hospital in South Korea, per the current protocol. Median overall survival (OS) was 21 months [95% confidence interval (CI): 18.1–23.9] in the levetiracetam (LEV) treatment group, whereas it was 16 months [95% CI: 14.1–17.9] in the group without LEV, exhibiting a statistically significant difference between the two groups (P < 0.001). Of nine AED groups, only LEV treatment [P = 0.001; hazard ratio (HR), 0.65; 95% CI: 0.51–0.83] exhibited a statistically significant difference in the OS, in the univariate analysis. In the risk analysis of the baseline characteristics, age, administration of LEV, and O6-methylguanine-DNA methyltransferase (MGMT) promoter status correlated with OS. The use of LEV in the group with a methylated MGMT promoter resulted in a positive impact on the OS [P = 0.006; HR, 0.174; 95% CI: 0.050–0.608], but the effect of LEV on the OS was not statistically significant in the unmethylated MGMT promoter group (P = 0.623). This study suggests that, compared with other AEDs, the administration of LEV may prolong the survival period in GBM patients with methylated MGMT promoters, who are undergoing chemotherapy with TMZ.

Highlights

Glioblastoma multiforme (GBM) is a lethal and aggressive malignant tumor of the central nervous system
The study protocol was approved by the Institutional Review Board (IRB) of the Yonsei University Health System (Seoul, South Korea; IRB No 4-2017-0659) and all data provided from hospital were anonymized and informed consent was waived by IRB
Of 628 consecutive patients diagnosed with GBM, 31 patients who had a follow-up at less than 3 months and 179 patients who did not receive either surgery, radiotherapy, or chemotherapy with TMZ were excluded

Summary

Introduction

Glioblastoma multiforme (GBM) is a lethal and aggressive malignant tumor of the central nervous system. GBM is characterized by nuclear atypia, astrocytic differentiation, cellular polymorphism, microvascular proliferation, and necrosis [1]. In 2013, the Central Brain Tumor Registry of the United States reported the incidence rate of GBM as only 3.19 per 100,000 [2]. Antiepileptic drugs affect survival of glioblastoma multiforme patients. 2 years without disease progression, despite adhering to protocol-based procedures for brain tumors [3,4]. The European Society for Medical Oncology (ESMO) recommends concomitant chemoradiotherapy (CCRT), radiotherapy for 5 days a week for 6 weeks along with daily TMZ (dose: 75 mg/m2) and, maintenance TMZ (dose: 150–200 mg/m2 dose) implemented daily for 5 days every 28 days for 6–12 cycles [5,6,7]

Objectives

Methods

Results

Discussion

Conclusion