How about Levetiracetam in Glioblastoma? An Institutional Experience and Meta-Analysis

SIMPLE SUMMARY: To date, there is a discrepancy regarding the role of antiepileptic drugs on glioblastoma survival. In the present study, based on large institutional cohort and enhanced with a meta-analysis of seven previously published studies, we show a robust association between the perioperative start of levetiracetam treatment with increased overall and progression-free survival in glioblastoma. Our results encourage the initiation of a prospective clinical trial to analyze the antitumor effect of levetiracetam in glioblastoma patients. ABSTRACT: Despite multimodal treatment, the prognosis of patients with glioblastoma (GBM) remains poor. Previous studies showed conflicting results on the effect of antiepileptic drugs (AED) on GBM survival. We investigated the associations of different AED with overall survival (OS) and progression-free survival (PFS) in a large institutional GBM cohort (n = 872) treated January 2006 and December 2018. In addition, we performed a meta-analysis of previously published studies, including this study, to summarize the evidence on the value of AED for GBM prognosis. Of all perioperatively administered AED, only the use of levetiracetam (LEV) was associated with longer OS (median: 12.8 vs. 8.77 months, p < 0.0001) and PFS (7 vs. 4.5 months, p = 0.001). In the multivariable analysis, LEV was independently associated with longer OS (aHR = 0.74, p = 0.017) and PFS (aHR = 0.68, p = 0.008). In the meta-analysis with 5614 patients from the present and seven previously published studies, outcome benefit for OS (HR = 0.83, p = 0.02) and PFS (HR = 0.77, p = 0.02) in GBM individuals with LEV was confirmed. Perioperative treatment with LEV might improve the prognosis of GBM patients. We recommend a prospective randomized controlled trial addressing the efficacy of LEV in GBM treatment.