Short Versus Long-term Levetiracetam in Brain Tumors

Trial Title: Short Versus Long-term Levetiracetam in Brain Tumors

NCT ID: NCT06442748

Condition: Seizures
Brain Tumors
Antiepileptics
Levetiracetam

Conditions: Official terms:
Brain Neoplasms
Seizures
Levetiracetam

Study type: Interventional

Study phase: Phase 3

Overall status: Recruiting

Study design:

Allocation: Randomized

Intervention model: Parallel Assignment

Primary purpose: Treatment

Masking: None (Open Label)

Intervention:

Intervention type: Drug
Intervention name: Levetiracetam
Description: Levetiracetam is usually preferred in brain tumor-related epilepsy. Levetiracetam is a second-generation antiepileptic drug that binds to synaptic vesicle glycoprotein SV2A, which interferes with the release of neurotransmitters from the synaptic vesicle and control seizure by multiple mechanisms.
Arm group label: EXPERIMENTAL
Arm group label: STANDARD

Summary: Levetiracetam is the commonly preferred anti-seizure medicine in patients with brain tumors. This drug has reduced the risk of seizure events occurring but is associated with a risk of side effects such as increased headache, drowsiness, loss of muscle coordination, and psychological challenges in patients. In patients undergoing appropriate treatment for brain tumors and controlled of seizures in the initial few months of levetiracetam, the chance of further seizures is relatively low. The optimal duration to give levetiracetam is not well defined for these patients, and currently as standard treatment levetiracetam is continued for 2-3 years. This study aims to answer this question by comparing patients on a short course of levetiracetam (experimental arm) versus a longer course of levetiracetam (standard arm), with the anticipation that a shorter duration of treatment will not lead to increased seizure episodes.

Detailed description: Patients with prior history of seizure from primary brain tumor in the supratentorial location with controlled seizure on levetiracetam monotherapy for at least six months will be considered for the study. Patients more than 18 years of age with KPS ≥ 50 will be eligible. Patients will be randomized in one of the two arms (standard arm or experimental arm) in a 1:1 ratio and stratified based on seizure type, location, histology, tumor grade, and adjuvant therapy. Randomization will be done by the statistician via computerized software using a permuted block design. In the standard arm, patients will continue on the same dose and schedule of levetiracetam (typically prescribed in the range of 1000-3000 mg/ day in 2-3 divided doses) for a duration of 2 years. In the experimental arm, levetiracetam will be tapered by 250- 500 mg every week and stopped. Follow-ups will be done every 3-6 months as per standard practice for the given tumor histology. Neuroimaging will be done 6-12 monthly as per routine clinical practice. The quality-of-life assessment will be done every six months. The primary endpoint is 2-year seizure free survival calculated from the time of randomization. Patients will continue to receive standard treatment, including adjuvant therapy as standard practice. In case in either arm, the patient develops a seizure episode after stopping levetiracetam will be restarted on levetiracetam monotherapy. If a patient develops a seizure episode while on levetiracetam monotherapy, further add-on antiepileptics will be considered as per standard practice by the responsible physician. Any complications arising from previous treatments (e.g., radio necrosis) or recurrent disease during the study period will be managed according to standard institutional practice without any influence of the study. The study will be conducted at Tata Memorial Centre with a total sample size of 604 patients for a duration of seven years.

Criteria for eligibility:
Criteria:
Inclusion Criteria: • Age ≥ 18years - History of seizure - Histological diagnosis of primary brain tumor - Supratentorial location of primary tumor - Controlled on levetiracetam monotherapy for 6 months - Index surgery within 1 year - Karnofsky Performance Scale (KPS) ≥ 50 Exclusion Criteria: - KPS < 50 - No history of seizure - Unclear history of seizure episodes in the past - Use of antiepileptics other than levetiracetam in the previous 6 months - No histological diagnosis - Progressive disease - Brain metastasis - Altered mental status with deficits in understanding or inability to consent to the study

Gender: All

Minimum age: 18 Years

Maximum age: N/A

Healthy volunteers: No

Locations:

Facility:
Name: Tata Memorial Centre

Address:
City: Mumbai
Zip: 400012
Country: India

Status: Recruiting

Contact:
Last name: Archya Dasgupta

Phone: 02224177000

Phone ext: 6861
Email: archya1010@gmail.com

Investigator:
Last name: Archya Dasgupta
Email: Principal Investigator

Start date: July 4, 2024

Completion date: June 1, 2031

Lead sponsor:
Agency: Tata Memorial Centre
Agency class: Other

Source: Tata Memorial Centre

Record processing date: ClinicalTrials.gov processed this data on November 12, 2024

Source: ClinicalTrials.gov page: https://clinicaltrials.gov/ct2/show/NCT06442748