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Lacosamide in monotherapy in BTRE (brain tumor-related epilepsy): results from an Italian multicenter retrospective study

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Abstract

Purpose

Lacosamide (LCM) is a third-generation anti-seizure medication (ASM) approved for focal onset epilepsy in patients aged ≥ 4.378 Previous studies have reported an efficacy of LCM as add-on treatment in brain tumor-related epilepsy (BTRE). To date, there are no studies in the literature focusing on lacosamide used in monotherapy to treat BTRE. In our retrospective study we investigated efficacy and tolerability of LCM in monotherapy in a multicenter national cohort of primary brain tumor patients.

Methods

We collected from 12 Italian Centers 132 patients with primary brain tumors who were treated with LCM in monotherapy. For each patient we evaluated seizure freedom at 3 and 6 months (primary endpoints), side effects and drop-out rate (secondary endpoints).

Results

Overall, LCM led to seizure freedom in 64.4% of patients at 3 months and 55% at 6 months. Patients who used two or more ASMs before LCM had a worse seizure control than patients in monotherapy with LCM as first choice.

In 14 patients, we observed seizure control despite tumor progression on magnetic resonance (MRI).

Multivariate analysis showed that gross-total resection at diagnosis was significantly associated with higher seizure freedom rate at 6 months.

Side effects were mainly mild (grade 1–2 according to CTCAE classification) and drop-out rate was low (1.5%). Main side effects were dizziness and somnolence.

Conclusions

This is the first study showing a good efficacy and tolerability of LCM when used in monotherapy in BTRE. Further prospective studies are needed to confirm these preliminary data, investigating also quality of life and neurocognitive functions.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Author information

Authors and Affiliations

  1. Division of Neuro-Oncology, Dept. Neuroscience, University and City of Health and Science Hospital, Via Cherasco 15, 10126, Torino, Italy

    F. Mo, F. Bruno, A. Pellerino & R. Rudà

  2. Division of Neurology, Modena University Hospital, Modena, Italy

    S. Meletti & G. Giovannini

  3. Center for Neuroscience and Neurotechnology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy

    S. Meletti

  4. Division of Neurology, Maggiore Hospital, Lodi, Italy

    V. Belcastro

  5. Division of Neurology, ASST Papa Giovanni XXIII of Bergamo, Bergamo, Italy

    S. Quadri & M. Sessa

  6. Division of Neurology and Stroke Unit, Hospital A. Cardarelli, Napoli, Italy

    M. Napolitano

  7. Division of Neurosurgical Oncology, Department of Oncology and Hemato-Oncology, Università Degli Studi Di Milano, Milan, Italy

    L. Bello & M. Conti Nibali

  8. Division of Neurology, Epilepsy Centre, Hospital of Venezia, Venice, Italy

    F. Dainese

  9. Division of Neurology, Department of Neuroscience, AOUI Verona, Verona, Italy

    M. Scarpelli

  10. Division of Neurology, Hospital of Parma, Parma, Italy

    I. Florindo

  11. IRCCS Neuromed, Pozzilli, Italy

    A. Mascia & G. Di Gennaro

  12. Neurology Unit, Department of Neuroscience, “S. Maria Della Misericordia” University Hospital, Udine, Italy

    G. Pauletto

  13. Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy

    G. Giovannini & F. Cavallieri

  14. Division of Neurosurgery, ASST Lariana, Como, Italy

    M. Polosa

  15. Department of Medicine (DAME), University of Udine, Udine, Italy

    G. L. Gigli

  16. Clinical Neurology Unit, “S. Maria Della Misericordia” University Hospital, Udine, Italy

    G. L. Gigli

  17. Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS Di Reggio Emilia, Reggio Emilia, Italy

    A. Pisanello & F. Cavallieri

  18. Division of Neurology, San Giacomo Hospital, AULSS2 Marca Trevigiana (TV), Treviso, Italy

    R. Rudà

Authors
  1. F. Mo
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  2. S. Meletti
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  3. V. Belcastro
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  22. R. Rudà
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Contributions

FM and RR: designed the study, performed data analysis and wrote the manuscript. SM, VB, SQ, MN, LB., FD, MS, IF, AM, GP, FB, AP, GG, MP, MS, MCN, GLG: contributed to collection of data, interpretation of the results, intellectual contents and critical revision of the draft AP and FC: contributed to critical revision of the draft.

Corresponding author

Correspondence to F. Mo.

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Conflict of interests

Mo F., Meletti S., Belcastro V., Quadri S., Napolitano M., Bello L., Dainese F., Scarpelli M., Florindo I., Mascia A., Pauletto G., Bruno F., Pellerino A., Giovannini G., Polosa M., Sessa M., Conti Nibali M., Gigli G.L., Pisanello A., Cavallieri F.: did not declare conflicts of interests. Di Gennaro G. joined advisory boards and pharmaceutical industry-sponsored symposia for EISAI, UCB, LivaNova, Arvelle. Rudà R. joined Advisory Boards and received grants from UCB, Mundipharma, Novocure and Bayer.

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Mo, F., Meletti, S., Belcastro, V. et al. Lacosamide in monotherapy in BTRE (brain tumor-related epilepsy): results from an Italian multicenter retrospective study. J Neurooncol 157, 551–559 (2022). https://doi.org/10.1007/s11060-022-03998-6

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