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Efficacy and Tolerability of Perampanel in Brain Tumor-Related Epilepsy: A Systematic Review

(1) Background: Epilepsy is a frequent comorbidity in patients with brain tumors, in whom seizures are often drug-resistant. Current evidence suggests that excess of glutamatergic activity in the tumor microenvironment may favor epileptogenesis, but also tumor growth and invasiveness. The selective...

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Autores principales: Rossi, Jessica, Cavallieri, Francesco, Bassi, Maria Chiara, Biagini, Giuseppe, Rizzi, Romana, Russo, Marco, Bondavalli, Massimo, Iaccarino, Corrado, Pavesi, Giacomo, Cozzi, Salvatore, Giaccherini, Lucia, Najafi, Masoumeh, Pisanello, Anna, Valzania, Franco
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10045654/
https://www.ncbi.nlm.nih.gov/pubmed/36979629
http://dx.doi.org/10.3390/biomedicines11030651
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author Rossi, Jessica
Cavallieri, Francesco
Bassi, Maria Chiara
Biagini, Giuseppe
Rizzi, Romana
Russo, Marco
Bondavalli, Massimo
Iaccarino, Corrado
Pavesi, Giacomo
Cozzi, Salvatore
Giaccherini, Lucia
Najafi, Masoumeh
Pisanello, Anna
Valzania, Franco
author_facet Rossi, Jessica
Cavallieri, Francesco
Bassi, Maria Chiara
Biagini, Giuseppe
Rizzi, Romana
Russo, Marco
Bondavalli, Massimo
Iaccarino, Corrado
Pavesi, Giacomo
Cozzi, Salvatore
Giaccherini, Lucia
Najafi, Masoumeh
Pisanello, Anna
Valzania, Franco
author_sort Rossi, Jessica
collection PubMed
description (1) Background: Epilepsy is a frequent comorbidity in patients with brain tumors, in whom seizures are often drug-resistant. Current evidence suggests that excess of glutamatergic activity in the tumor microenvironment may favor epileptogenesis, but also tumor growth and invasiveness. The selective non-competitive α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor antagonist perampanel (PER) was demonstrated to be efficacious and well-tolerated in patients with focal seizures. Moreover, preclinical in vitro studies suggested a potential anti-tumor activity of this drug. In this systematic review, the clinical evidence on the efficacy and tolerability of PER in brain tumor-related epilepsy (BTRE) is summarized. (2) Methods: Five databases and two clinical trial registries were searched from inception to December 2022. (3) Results: Seven studies and six clinical trials were included. Sample size ranged from 8 to 36 patients, who received add-on PER (mean dosage from 4 to 7 mg/day) for BTRE. After a 6–12 month follow-up, the responder rate (% of patients achieving seizure freedom or reduction ≥ 50% of seizure frequency) ranged from 75% to 95%, with a seizure freedom rate of up to 94%. Regarding tolerability, 11–52% of patients experienced non-severe adverse effects (most frequent: dizziness, vertigo, anxiety, irritability). The retention rate ranged from 56% to 83%. However, only up to 12.5% of patients discontinued the drug because of the adverse events. (4) Conclusions: PER seems to be efficacious, safe, and well-tolerated in patients with BTRE. Further randomized studies should be conducted in more homogeneous and larger populations, also evaluating the effect of PER on tumor progression, overall survival, and progression-free survival.
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spelling pubmed-100456542023-03-29 Efficacy and Tolerability of Perampanel in Brain Tumor-Related Epilepsy: A Systematic Review Rossi, Jessica Cavallieri, Francesco Bassi, Maria Chiara Biagini, Giuseppe Rizzi, Romana Russo, Marco Bondavalli, Massimo Iaccarino, Corrado Pavesi, Giacomo Cozzi, Salvatore Giaccherini, Lucia Najafi, Masoumeh Pisanello, Anna Valzania, Franco Biomedicines Systematic Review (1) Background: Epilepsy is a frequent comorbidity in patients with brain tumors, in whom seizures are often drug-resistant. Current evidence suggests that excess of glutamatergic activity in the tumor microenvironment may favor epileptogenesis, but also tumor growth and invasiveness. The selective non-competitive α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor antagonist perampanel (PER) was demonstrated to be efficacious and well-tolerated in patients with focal seizures. Moreover, preclinical in vitro studies suggested a potential anti-tumor activity of this drug. In this systematic review, the clinical evidence on the efficacy and tolerability of PER in brain tumor-related epilepsy (BTRE) is summarized. (2) Methods: Five databases and two clinical trial registries were searched from inception to December 2022. (3) Results: Seven studies and six clinical trials were included. Sample size ranged from 8 to 36 patients, who received add-on PER (mean dosage from 4 to 7 mg/day) for BTRE. After a 6–12 month follow-up, the responder rate (% of patients achieving seizure freedom or reduction ≥ 50% of seizure frequency) ranged from 75% to 95%, with a seizure freedom rate of up to 94%. Regarding tolerability, 11–52% of patients experienced non-severe adverse effects (most frequent: dizziness, vertigo, anxiety, irritability). The retention rate ranged from 56% to 83%. However, only up to 12.5% of patients discontinued the drug because of the adverse events. (4) Conclusions: PER seems to be efficacious, safe, and well-tolerated in patients with BTRE. Further randomized studies should be conducted in more homogeneous and larger populations, also evaluating the effect of PER on tumor progression, overall survival, and progression-free survival. MDPI 2023-02-21 /pmc/articles/PMC10045654/ /pubmed/36979629 http://dx.doi.org/10.3390/biomedicines11030651 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Systematic Review
Rossi, Jessica
Cavallieri, Francesco
Bassi, Maria Chiara
Biagini, Giuseppe
Rizzi, Romana
Russo, Marco
Bondavalli, Massimo
Iaccarino, Corrado
Pavesi, Giacomo
Cozzi, Salvatore
Giaccherini, Lucia
Najafi, Masoumeh
Pisanello, Anna
Valzania, Franco
Efficacy and Tolerability of Perampanel in Brain Tumor-Related Epilepsy: A Systematic Review
title Efficacy and Tolerability of Perampanel in Brain Tumor-Related Epilepsy: A Systematic Review
title_full Efficacy and Tolerability of Perampanel in Brain Tumor-Related Epilepsy: A Systematic Review
title_fullStr Efficacy and Tolerability of Perampanel in Brain Tumor-Related Epilepsy: A Systematic Review
title_full_unstemmed Efficacy and Tolerability of Perampanel in Brain Tumor-Related Epilepsy: A Systematic Review
title_short Efficacy and Tolerability of Perampanel in Brain Tumor-Related Epilepsy: A Systematic Review
title_sort efficacy and tolerability of perampanel in brain tumor-related epilepsy: a systematic review
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10045654/
https://www.ncbi.nlm.nih.gov/pubmed/36979629
http://dx.doi.org/10.3390/biomedicines11030651
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