Abstract Details

Title Exploration of Levetiracetam Dose and Clinical Outcomes in Tumor-associated Epilepsy

Topic Neuro-oncology

Presentation(s) P3 - Poster Session 3 (11:45 AM-12:45 PM)

Poster/Presentation
Number 6-006

Objective We explore the impact of levetiracetam dose on both cancer survival and seizure outcomes to assess whether patients with high-grade glioma (HGG)-associated epilepsy may benefit from future disease-specific dosing guidelines.

Background Levetiracetam is a widely-preferred first line therapy for tumor-associated epilepsy. Preclinical studies propose that levetiracetam sensitizes malignant glioma cells to the methylating agent temozolomide. However, clinical studies have shown mixed results between levetiracetam and HGG outcomes, and there is minimal data on optimal levetiracetam dosing in tumor-associated epilepsy. A more thorough understanding of the relationship between levetiracetam and clinical outcomes may help guide prescribing.

Design/Methods We identified 422 patients with co-occurring HGG and epileptic activity. Multivariable linear regressions were applied to the full patient sample as well as patients who did and did not receive standard-of-care (SOC) chemoradiation with temozolomide (SOC+/-). Levetiracetam dose was analyzed both as a numeric variable and as a Low (<2000mg/day) versus High (≥2000mg/day) categorical variable. Age, sex, targeted anticancer therapies, gross total resection, and MGMT methylation status were included as additional variables. Outcomes included progression-free and overall survival (PFS and OS), achievement of a six-month seizure remission, and duration of seizure remission.

Results In the full patient sample, initial treatment with levetiracetam associated with significantly increased likelihood of achieving seizure remission (p = 0.0019), but not with improved PFS or OS. The SOC+ group likewise demonstrated a significant association (p = 0.00163) between levetiracetam and seizure remission, a finding not seen in the SOC- group. In all analyzed groups, levetiracetam dose did not associate with any outcomes of interest.

Conclusions

Levetiracetam may provide better control of epileptic activity in HGG-associated epilepsy for patients who receive temozolomide. Levetiracetam dose does not demonstrate any association with outcomes in this retrospective sample; a prospective controlled study would offer additional insight on the value of HGG-specific levetiracetam dosing guidelines.

Authors/Disclosures
Ryan Rilinger PRESENTER	Mr. Rilinger has nothing to disclose.
Akshay Sharma (Cleveland Clinic Foundations)	Akshay Sharma has nothing to disclose.
Marina Feldman, PharmD	Dr. Feldman has nothing to disclose.
Lydia Guo	Ms. Guo has a non-compensated relationship as a Board of Directors with National Alzheimer's Buddies that is relevant to AAN interests or activities.
Josephine Volovetz, MD	Dr. Volovetz has nothing to disclose.
Matthew Grabowski	Matthew Grabowski has nothing to disclose.
Mina Lobbous, MD (Cleveland Clinic Foundation)	Dr. Lobbous has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Servier . Dr. Lobbous has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion Pharmaceuticals . Dr. Lobbous has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Telix pharmaceuticals . Dr. Lobbous has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Springworks Pharmaceuticals . Dr. Lobbous has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Springworks Pharmaceuticals . Dr. Lobbous has received publishing royalties from a publication relating to health care.

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