scholarly journals AB1049 CLINICAL SPECTRUM AND THERAPEUTIC MANAGEMENT OF AUTO-IMMUNE MYELOFIBROSIS: A NATION-WIDE STUDY OF 30 CASES

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1815.4-1815
Author(s):  
P. Mertz ◽  
E. Chalayer ◽  
J. Sibilia ◽  
J. E. Gottenberg ◽  
A. S. Korganow ◽  
...  
Keyword(s):  
Complete Response ◽  
High Rate ◽  
Response To Treatment ◽  
Rare Entity ◽  
First Line Therapy ◽  
Reticulin Fibers ◽  
First Choice ◽  
Life Threatening ◽  
Diagnosis Criteria

Background:Little is known about autoimmune myelofibrosis (AIMF), a rare entity that can occur alone or in association with another autoimmune disease (AID) and is responsible for bone marrow (BM) failure and life-threatening complications.Objectives:We conducted a nationwide retrospective observational study of AIMF cases to better characterize the epidemiology, clinical presentation and evolution of this rare entity.Methods:The aim of the study was to analyze the characteristics of AIMF and the nature and indication of treatments currently used. Response to treatment was evaluated by the revised Tefferi et al. response criteria.Results:Among 30 cases of AIMF, the sex ratio (F/M) was 4:1 and the median age at diagnosis was 37 years (interquartile range 30–49). AIMF was diagnosed after the onset of an associated AID in 12 cases and concomitant to an AID in the remaining 18 cases. The most frequently associated AID was systemic lupus erythematous, followed by Sjögren syndrome. All cases consisted of reticulin fibers, and no collagen fibrosis was described. More than 50% of cases showed complete response after first-line therapy, with glucocorticoids (GC) in 28 cases. Half of the cases had treatment complications mainly related to GC therapy.Conclusion:Diagnosis of AIMF remains challenging in the absence of a validated set of diagnosis criteria, and must always be searched in the presence of hematological abnormalities at onset or during follow-up of AID. Clinical context, search for mutations and pathology findings can help differentiating this rare disease from a clonal pathology. GC is currently an effective first-choice therapy for AIMF, but a high rate of GC dependency and long-term complications indicate the need to find new sparing drugs.Disclosure of Interests:PHILIPPE MERTZ: None declared, Emilie Chalayer: None declared, Jean Sibilia: None declared, Jacques-Eric Gottenberg Grant/research support from: BMS, Pfizer, Consultant of: BMS, Sanofi-Genzyme, UCB, Speakers bureau: Abbvie, Eli Lilly and Co., Roche, Sanofi-Genzyme, UCB, Anne-Sophie Korganow: None declared, Laurent Arnaud: None declared, Thierry Martin: None declared

scholarly journals Durable Long-Term Remission With Chemotherapy Alone for Stage II to IV Laryngeal Cancer

2009 ◽  
Vol 27 (12) ◽  
pp. 1976-1982 ◽  
Author(s):  
F. Christopher Holsinger ◽  
Merrill S. Kies ◽  
Eduardo M. Diaz ◽  
Ann M. Gillenwater ◽  
Jan S. Lewin ◽  
...  
Keyword(s):  
Laryngeal Cancer ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Concurrent Chemotherapy ◽  
Stage Ii ◽  
High Rate ◽  
Disease Remission ◽  
Laryngeal Surgery ◽  
Platinum Based Chemotherapy

Purpose For patients with stage II to IV laryngeal cancer, radiation therapy (RT) either alone or with concurrent chemotherapy provides the highest rate of organ preservation but can be associated with functional impairment. Thus, we studied the use of induction chemotherapy with or without conservation laryngeal surgery (CLS). Our objectives were to study the sensitivity of laryngeal cancer to platinum-based chemotherapy alone and to highlight the efficacy of CLS in this setting. Patients and Methods Thirty-one previously untreated patients with laryngeal cancer (T2-4, N0-1, M0), who were resectable with CLS, were enrolled. Patients received three to four cycles of paclitaxel, ifosfamide, and cisplatin (TIP) chemotherapy, and response was assessed histologically. Patients with partial response (PR) proceeded to CLS. Patients achieving pathologic complete response (pCR) received an additional three cycles of TIP and no other treatment. Results Thirty patients were assessable for response. With TIP chemotherapy alone, 11 patients (37%) achieved pCR, 10 of whom (33%) remain alive with durable disease remission and no evidence of recurrence over a median follow-up time of 5 years. Nineteen patients (63%) treated with TIP alone achieved PR. The overall laryngeal preservation (LP) rate was 83%, and only five patients (16%) required postoperative RT. No patient required a gastrostomy tube or tracheotomy. Conclusion Chemotherapy alone in selected patients with T2-4, N0-1 laryngeal cancer can provide durable disease remission at 5 years. For patients with PR, CLS provides a high rate of LP. This prospective study suggests that chemotherapy alone may cure selected patients with laryngeal cancer, warranting further prospective investigation.

Provision of Sedation and Treatment of Seizures During Neonatal Therapeutic Hypothermia

2020 ◽  
Vol 39 (4) ◽  
pp. 227-235
Author(s):  
Christopher McPherson ◽  
Keliana O'Mara
Keyword(s):  
Therapeutic Hypothermia ◽  
Adverse Outcomes ◽  
High Rate ◽  
Neonatal Seizures ◽  
Long Term Effects ◽  
First Line Therapy ◽  
Pharmacokinetic Properties ◽  
Traditional Therapies ◽  
Interesting Alternative

Hypoxic-ischemic encephalopathy (HIE) produces a high rate of long-term neurodevelopmental disability in survivors. Therapeutic hypothermia dramatically improves the incidence of intact survival, but does not eliminate adverse outcomes. The ideal provision of sedation and treatment of seizures during therapeutic hypothermia represent therapeutic targets requiring optimization in practice. Physiologic stress from therapeutic hypothermia may obviate some of the benefits of this therapy. Morphine is commonly utilized to provide comfort, despite limited empiric evidence supporting safety and efficacy. Dexmedetomidine represents an interesting alternative, with preclinical data suggesting direct efficacy against shivering during induced hypothermia and neuroprotection in the setting of HIE. Pharmacokinetic properties must be considered when utilizing either agent, with safety dependent on conservative dosing and careful monitoring. HIE is the leading cause of neonatal seizures. Traditional therapies, including phenobarbital, fosphenytoin, and benzodiazepines, control seizures in the vast majority of neonates. Concerns about the acute and long-term effects of these agents have led to the exploration of alternative anticonvulsants, including levetiracetam. Unfortunately, levetiracetam is inferior to phenobarbital as first-line therapy for neonatal seizures. Considering both the benefits and risks of traditional anticonvulsant agents, treatment should be limited to the shortest duration indicated, with maintenance therapy reserved for neonates at high risk for recurrent seizures.

scholarly journals Azacitidine and Durvalumab in First-line Treatment of Elderly Patients With Acute Myeloid Leukemia

2021 ◽  
Author(s):  
Amer M. Zeidan ◽  
Isaac Wayne Boss ◽  
CL Beach ◽  
Wilbert B. Copeland ◽  
Ethan Greene Thompson ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Complete Response ◽  
Response To Treatment ◽  
First Line ◽  
First Line Therapy ◽  
Mutational Status ◽  
Programmed Death ◽  
Duration Of Response ◽  
Acute Myeloid

Evidence suggests that combining immunotherapy with hypomethylating agents may enhance antitumor activity. This phase 2 study investigated the activity and safety of durvalumab, a programmed death ligand 1 (PD-L1) inhibitor, combined with azacitidine for patients aged ≥65 years with acute myeloid leukemia (AML), including analyses to identify biomarkers of treatment response. Patients were randomized to first-line therapy with azacitidine 75 mg/m2 on days 1-7 with (Arm A, n= 64) or without (Arm B, n=65) durvalumab 1500 mg on day 1 every 4 weeks. Overall response rate (complete response [CR] + CR with incomplete blood recovery [CRi]) was similar in both arms (Arm A, 31.3%; Arm B, 35.4%), as were overall survival (A, 13.0 months; B, 14.4 months) and duration of response (A, 24.6 weeks; B, 51.7 weeks; P=0.0765). No new safety signals emerged with combination treatment. The most frequently reported treatment-emergent adverse events were constipation (Arm A, 57.8%; Arm B, 53.2%) and thrombocytopenia (A, 42.2%; B, 45.2%). DNA methylation, mutational status, and PD-L1 expression were not associated with response to treatment. In this study, first-line combination therapy with durvalumab and azacitidine in older patients with AML was feasible, but did not improve clinical efficacy compared with azacitidine alone. ClinicalTrials.gov: NCT02775903

Concordance with National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines (CPGs): A Quality of Care Tool for Newly Diagnosed Patients (pts) with Mantle Cell Lymphoma (MCL).

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3328-3328
Author(s):  
Maria Alma Rodriguez ◽  
Anna Ter Veer ◽  
Auayporn Nademanee ◽  
Joyce Niland ◽  
Eva Lepisto ◽  
...  
Keyword(s):  
Standard Dose ◽  
High Rate ◽  
Stage Iii ◽  
Newly Diagnosed ◽  
First Line ◽  
Nccn Guidelines ◽  
First Line Therapy ◽  
Line Therapy

Abstract Introduction: In 1999, the NCCN published its first NHL CPG and in 2000, established the NCCN NHL Outcomes Database Project to monitor patterns of care, CPG concordance and outcomes in participating institutions. We report here on clinical characteristics and CPG concordance among newly diagnosed (dx) pts with MCL in the database. Methods: We prospectively collected demographic, staging, and treatment information on consecutive pts with MCL presenting at 5 geographically diverse NCCN institutions (Dana-Farber, Roswell Park, City of Hope, Fox Chase and MD Anderson). We assessed concordance with 2 CPG’s relevant to the concordance impacting the majority of pts: 1) bone marrow biopsy (BMBx) as part of the initial work-up and 2) use of an endorsed first line regimen among pts with stage III/IV disease. CPG concordance was assessed by comparing each pt’s care against the version on the NCCN guideline in effect at the time the pt was diagnosed. Results: Between 7/2000 and 10/2005, we enrolled 132 MC evaluable pts. Median age was 58; 43% had high-intermediate or high risk disease according to the IPI at presentation; 123 (93%) pts presented with stage III/IV disease. The median follow-up was 22.6 months. Overall, 91% of pts underwent a staging BMBx as recommended by the guidelines. Concordance varied by institution, low 78% to high 98%. Among 123 pts with stage III/IV disease, first-line therapy was concordant with CPG recommendations in only 59%. Use of rituximab accounted for 92% of all non-concordance. When the guidelines were modified in 2003 to include rituximab as an option for first-line therapy of MCL, concordance rose from 31% (2000) to 100% (2003–5). Of concordant pts receiving combination chemotherapy, 33% received CHOP-based standard dose therapy and 62% received dose-intense therapy. NCCN guidelines consider all therapy administered as part of a clinical trial to be concordant; trial-directed treatment accounted for 42% of concordant care. Conclusions: Our data suggest that the majority of MCL pts in these centers receive care that is concordant with current standards. In this subgroup of patients, participation in clinical trials occurred at an impressively high rate. However, not all pts undergo BMBx as a routine component of staging as recommended by NCCN guidelines suggesting that this is an area for potential quality improvement. This study also highlights that differences in management exist even within national comprehensive cancer centers. Because long-term follow-up is possible with this database, future studies will assess the initial treatment and guideline concordance on long-term outcomes in this unique group of pts.

Non Predictive Value of An Initial Tc-99m-MIBI Scintigraphy On the Prediction of Therapeutic Outcome in Non Hodgkin and Hodgkin Lymphoma: Preliminary Results of a Prospective Study in 81 Patients.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4762-4762
Author(s):  
Marie-Pierre Gourin ◽  
Jacques Monteil ◽  
Benoit Marin ◽  
Stéphane Girault ◽  
Natalya Dmytruk ◽  
...  
Keyword(s):  
Prospective Study ◽  
Predictive Value ◽  
Complete Response ◽  
Therapeutic Outcome ◽  
Response To Treatment ◽  
High Grade ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
Mibi Scintigraphy

Abstract Abstract 4762 Introduction Tc-99m-MIBI, a radioactive tracer used in routine to explore myocardial perfusion, parathyroids or in oncology for high-grade glioma, has been described as a promising agent for the functional characterization of p-glyco-protein expression and the prediction of the therapeutic outcome in patients (pts) with Hodgkin (HL) and non-Hodgkin's lymphoma (NHL)( Liang LA, 2001; Kao CH 2002). As resistance to chemotherapy is the major cause of treatment failure in NHL, the goal of treatment is to avoid an incomplete response after first line chemotherapy. This prospective study was designed to investigate the relationship between uptake by Tc-99m-MIBI scintigraphy and response to treatment in aggressive and follicular NHL, and HL. Patients and Methods Study protocol was a monocentric prospective study conducted between 10/2005 and 11/2008. Inclusion criteria included untreated pts with a histological diagnosis of HL or high grade NHL or follicular (FL) and managed in a hematological regional care network: HEMATOLIM, aged 18 years and more, with an initial and final assessment by a CT scan and/or TEP scan and with an informed consent. Were excluded pregnant or lactating women, pts without social security coverage or with initial corticosteroids. During the initial assessment, a Tc-99m-MIBI was performed with an injection of 20 mCi of tracer before any therapeutics. Images were obtained 10 minutes after intra-venous injection of Tc-MIBI. The rate of complete response (CR) and incomplete response (IR) at the end of first line therapy was evaluated with and compared with MIBI uptake. Results The study included 81pts, sex ratio 1.61, median age 55 years (18-84)with an histological diagnosis of HL 41.9% (n=34), FL 9.9% (n=8), and aggressive NHL 48.2% (n=39) including DLBCL 38.3% (n=31), T cell NHL 4.9% (n=4), NK cell NHL 2.5% (n=2) and MCL 2.5% (n=2). Stade Ann Arbor I 6.2% (n=5), II 43.2% (n=35), III 12.3% (n=10) and IV 38.3% (n=31). Performans status were 0 for 51.85% (n=42), 1 for 35.8% (n=29), 2 for 11.11% (n=9) and 3 for 1.24% (n=1). LDH rate were increased 28.4% (n=23), normal 69.1% (n=56) and missing 2.5% (n=2). PSS for HL was favorable 41.18% (n=14), intermediate 47.06 (n=16) and unfavorable 11.76% (n=4). FLIPI score for FL was favorable 25% (n=2), intermediate for 62.5% (n=5) and non favorable for 12.5% (n=1). IPIa score was 0 for 29.03% (n=9), 1 for 32.26% (n=10), 2 for 19.35% (n=6) and 3 for 19.35% (n=6). All patients received chemotherapy in first line. For unfavorable pts a consolidation therapy has been added by radiotherapy 27.16% (n=22), or autologous stem cell transplantation for 8.54% (n=7). For 81 pts, MIBI results had positive uptake (MIBI+) 77.8% (n=63) and no uptake (MIBI-) 22.2% (n=18). For 75/81 pts eligible for final evaluation (6 deaths due to toxicity (n=3) or to NHL (n=3)), MIBI results showed 76% (n=57) MIBI+ and 24% (n=18) MIBI-. At the end of first line therapy, 82% of MIBI+ (n= 48/57) at diagnosis were in CR and 83% of MIBI – (15/18) were also in CR. There was no significant difference between the rate of MIBI+ and MIBI- for pts in CR by histological type. The distribution of disease localization were : thoracic (T) 59.3% (n=48), thoraco-abdominal (TA) 24.7% (n=20), abdominal (A) 13.6% (n=11), cranial 1.2% (n=1) and knee 1.2% (n=1). According to the results of MIBI, 83% of pts with a T localization were MIBI+ (n=40) versus 17% MIBI- (n=8), 70% of pts with a TA localization were MIBI+ (n=14) versus 30% MIBI- (n=6) and 63% of patients with a A localization were MIBI+ (n=7) versus 37% MIBI- (n=4). OS at 3 years is 90% and 3 years PFS is 79% with no significantly difference according to the response to MIBI. Sensitivity of MIBI is 80.77%, specificity 27.59%, positive predictive value is 66.67% and negative predictive value 44.44%. Conclusion This prospective study on 81 untreated pts with HL, and several varieties of aggressive NHL do not confirm the encouraging results previously reported by an asian study obtained on 25 pts considering Tc-99m as a useful predictive tool for chemoresistance. In our study, lack of MIBI uptake does not predict a decrease in the rate of complete response to treatment. Several explanations can be advanced: heterogeneous histology and prognostic score, small population. Disclosures: No relevant conflicts of interest to declare.

scholarly journals P.012 Treatment and long-term follow-up of primary CNS classical Hodgkin’s Lymphoma – a case report and review of the literature

2017 ◽  
Vol 44 (S2) ◽  
pp. S17-S17
Author(s):  
PA Szelemej ◽  
M Bigder ◽  
J Krcek
Keyword(s):  
Case Report ◽  
Hodgkin’S Lymphoma ◽  
Central Nervous System Involvement ◽  
Complete Response ◽  
Hodgkin's Lymphoma ◽  
Response To Treatment ◽  
Term Survival ◽  
Whole Brain Radiation ◽  
Long Term Follow Up

Background: Unlike non-Hodgkin’s lymphoma, central nervous system involvement with classical Hodgkin’s lymphoma is exceedingly rare, thus information regarding treatment and prognostication of the disease is lacking. Methods: This case report was prepared using hospital charts, and PubMed for the literature search. Our case was compared and contrasted against similar cases in the literature. Results: We present the case of a 47 year old female who presented with a left parietal dural-based lesion which proved to be Stage IE primary CNS classical Hodgkin’s lymphoma. After surgery and whole brain radiation therapy, the patient has remained in complete remission over nine years. Conclusions: Despite the dearth of information available regarding CNS Hodgkin’s lymphoma, our case is consistent with the findings in the literature that long-term survival is possible in patients achieving a complete response to treatment, especially in those patients who present with sole CNS involvement. To our knowledge, this represents the longest reported survival in the literature and contributes to our understanding of prognosis in patients with CNS Hodgkin’s lymphoma.

scholarly journals Chimeric antigen receptor T cells self-neutralizing IL6 storm in patients with hematologic malignancy

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Lei Xue ◽  
Yan Yi ◽  
Qianwen Xu ◽  
Li Wang ◽  
Xiaohui Yang ◽  
...  
Keyword(s):  
Chimeric Antigen Receptor ◽  
Clinical Investigation ◽  
Hematologic Malignancy ◽  
Antigen Receptor ◽  
Complete Response ◽  
High Rate ◽  
Car T ◽  
Life Threatening ◽  
Low Levels

AbstractIL6 is one of the most elevated cytokines during chimeric antigen receptor (CAR) T cell cytokine release syndrome (CRS), and IL6R blockade by Tocilizumab has successfully relieved the most life-threatening aspects of CRS in patients. In addition, latest studies demonstrated the essential role of IL1 in driving CART induced neurotoxicity in mouse models. Here we present a clinical investigation (ChiCTR2000032124; ChiCTR2000031868) of anti-CD19 and anti-BCMA CART (41BBζ) secreting an anti-IL6 scFv and IL1 receptor antagonist (IL1RA) in treating patients with hematologic malignancy. Our results revealed that IL6 and IL1B were maintained at low levels without significant elevation during CRS, rendering Tocilizumab dispensable. Moreover, treated patients did not show neurotoxicity during CRS and exhibited mild to moderate CRS. Notably, we observed high rate of complete response (CR) and significant CART expansion during treatment. In sum, we conclude that CART-secreting anti-IL6 scFv and IL1RA could self-neutralize IL6 storm and maintain low levels of IL1B during CART therapy to minimize IL6- and IL1-associated cytokine toxicity and neurotoxicity without impairing therapeutic efficacy.

Long-term salvage therapy with cyclosporin A in refractory idiopathic thrombocytopenic purpura

Blood ◽  
2002 ◽  
Vol 99 (4) ◽  
pp. 1482-1485 ◽  
Author(s):  
Giovanni Emilia ◽  
Monica Morselli ◽  
Mario Luppi ◽  
Giuseppe Longo ◽  
Roberto Marasca ◽  
...  
Keyword(s):  
Cyclosporin A ◽  
Idiopathic Thrombocytopenic Purpura ◽  
Complete Response ◽  
Term Treatment ◽  
Thrombocytopenic Purpura ◽  
Long Term Treatment ◽  
Life Threatening ◽  
Difficult Challenge

Treatment of severe, chronic idiopathic thrombocytopenic purpura (ITP) refractory to most usual therapies is a difficult challenge. Little information exists on the clinical use of cyclosporin A (CyA) in the treatment of ITP. This report describes long-term treatment with CyA (median, 40 months) and follow-up (median, 36.8 months) in 12 adult patients with resistant ITP. CyA used in relatively low doses (2.5-3 mg/kg of body weight per day) led to a clinical improvement in 10 patients (83.3%). Five had a complete response (41.1%), 4 a complete response to maintenance therapy (33.3%), and one a partial response (8.3%). Two patients had no response. Most patients with a response (60%) had a long-term remission (mean, 28.6 months) after discontinuation of CyA. One patient had a relapse of ITP 4 years after CyA therapy was stopped. Side effects were moderate and transient, even in patients dependent on continued CyA treatment. CyA seems to represent reasonable salvage treatment in severe, potentially life-threatening, refractory ITP.

Prolonged Progression Free Survival Does Not Relate to Quality of Response to Treatment with Thalidomide in Patients with Relapsed Multiple Myeloma (MM).

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 2718-2718
Author(s):  
Hang Quach ◽  
Miles H. Prince ◽  
Linda Mileshkin ◽  
John F. Seymour ◽  
David Westerman ◽  
...  
Keyword(s):  
Phase Ii ◽  
Progression Free Survival ◽  
Complete Response ◽  
Response To Treatment ◽  
Phase Ii Trials ◽  
Term Survival ◽  
Free Survival ◽  
Multicentre Phase

Abstract Introduction: Quality of response to treatment in relapse/refractory MM, especially complete response (CR) or near complete response (nCR), has been reported to correlate with better PFS and OS in the past (Hussein MA, et al. Mayo Clin Proc2006;81:889–95). In this report, we provide an update on long-term survival from two multicentre phase II trials using thalidomide +/- IFNα2B (MM-thal) and combination celecoxib-thalidomide (Cel-thal) in relapsed or refractory MM, and identify predictors of progression-free survival (PFS) beyond 24 months (m). Method: In 1998 and 2001, two prospective multicentre phase-II trials in relapsed or refractory MM were performed to assess the efficacy of thalidomide +/- IFNα2B (MM-thal), and combination celecoxib-thalidomide (Cel-thal), respectively. Both studies were previously reported (Blood2003;102:69; Clin Can Res2005;11:5504). The analysis of progression free survival (PFS) has been updated using the Kaplan-Meier method. Baseline characteristics were compared between patients having PFS ≥ 24m and < 24m using fisher’s exact test or the Cochran-Armitage test, to identify predictors of long-term disease control. Result: Median follow up for MM-thal (n=75) and Cel-thal (n=66) trials were 73m and 47m respectively. Median PFS in the MM-thal trial was 5.5m, with estimated PFS of 9% at 3 years (95%, CI:5-18%), and 5% at 5 years (95%, CI:2-13%). In the Cel-thal trial, median PFS was 6.8m, with estimated PFS of 21% at 3 years (95% CI: 13-33%) and 16% at 5 years (95% CI:9-27%). Overall, 27 out of 141 patients (10 from MM-thal, 17 from Cel-thal) had PFS beyond 24m. The majority of these long term responders (70%) achieved only a PR as the best response to thalidomide-based treatment;15% achieved complete response (CR), and 15% had stable disease (SD). The most significant predictors for prolonged PFS of ≥24m was β2M ≥3mg/l (p<0.0005), stage ≥2 disease (p=0.001), and non-refractory disease to previous therapy (p=0.03). Bone marrow plasma cell infiltrate following thalidomide did not predict for outcome. Conclusion: Thalidomide, and in particular combination celecoxib-thalidomide has substantial activity in relapsed MM with prolonged PFS beyond 24m in approximately 19% of patients. The strongest predictor of prolonged PFS is β2M. The depth of response to thalidomide had little influence on predicting remission duration.

scholarly journals Anticonvulsant therapy in brain-tumor related epilepsy

2016 ◽  
Vol 24 (1) ◽  
pp. 41-56
Author(s):  
Walter Fröscher ◽  
Timo Kirschstein ◽  
Johannes Rösche
Keyword(s):  
Brain Tumor ◽  
Epileptic Seizures ◽  
Current Evidence ◽  
Chemotherapeutic Drugs ◽  
First Line ◽  
Tumor Patients ◽  
First Line Therapy ◽  
Line Therapy ◽  
First Choice

SummaryBackground. The lifetime risk of patients with brain tumors to have focal epileptic seizures is 10-100%; the risk depends on different histology. Specific guidelines for drug treatment of brain tumor-related seizures have not yet been established.Aim. This review addresses the special aspects of antiepileptic drug (AED) therapy in brain tumor-related epilepsy.Methods. We analyzed the literature up to December 2015.Results. Based on current evidence the management of tumor-related seizures does not differ substantially from that applied to epilepsies from other etiologies. Therefore, the choice of an AED is based, above all, on tolerability and pharmacokinetic interactions with chemotherapeutic drugs. Levetiracetam is recommended by many authors as first-line therapy in brain tumor-related epilepsy. Due to the possibility of interactions, the combination of enzyme-inducing AEDs and chemotherapeutic drugs, is usually not recommended as a first choice. Currently there is no evidence that prophylactic prescription of long-term AEDs in brain tumor-patients who did not present with seizures is justified. Because of the high risk of recurrence, however, AED treatment should be strongly considered after a single brain tumor-related seizure. The decision to withdraw AEDs must carefully consider the risk of seizure recurrence.Conclusion. At present levetiracetam is the preferred drug in brain tumor-related epilepsy, especially when drug interactions need to be avoided. In the future we hope to acquire more targeted drugs against this disorder by uncovering its pathogenesis.

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