Cargando…
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...
Autores principales: | , , , , , , , , , , , , , |
---|---|
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 |
_version_ | 1784913657299206144 |
---|---|
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. |
format | Online Article Text |
id | pubmed-10045654 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
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 |
work_keys_str_mv | AT rossijessica efficacyandtolerabilityofperampanelinbraintumorrelatedepilepsyasystematicreview AT cavallierifrancesco efficacyandtolerabilityofperampanelinbraintumorrelatedepilepsyasystematicreview AT bassimariachiara efficacyandtolerabilityofperampanelinbraintumorrelatedepilepsyasystematicreview AT biaginigiuseppe efficacyandtolerabilityofperampanelinbraintumorrelatedepilepsyasystematicreview AT rizziromana efficacyandtolerabilityofperampanelinbraintumorrelatedepilepsyasystematicreview AT russomarco efficacyandtolerabilityofperampanelinbraintumorrelatedepilepsyasystematicreview AT bondavallimassimo efficacyandtolerabilityofperampanelinbraintumorrelatedepilepsyasystematicreview AT iaccarinocorrado efficacyandtolerabilityofperampanelinbraintumorrelatedepilepsyasystematicreview AT pavesigiacomo efficacyandtolerabilityofperampanelinbraintumorrelatedepilepsyasystematicreview AT cozzisalvatore efficacyandtolerabilityofperampanelinbraintumorrelatedepilepsyasystematicreview AT giaccherinilucia efficacyandtolerabilityofperampanelinbraintumorrelatedepilepsyasystematicreview AT najafimasoumeh efficacyandtolerabilityofperampanelinbraintumorrelatedepilepsyasystematicreview AT pisanelloanna efficacyandtolerabilityofperampanelinbraintumorrelatedepilepsyasystematicreview AT valzaniafranco efficacyandtolerabilityofperampanelinbraintumorrelatedepilepsyasystematicreview |