ESTRO 2024 - Abstract Book

S2838

Interdisciplinary - Health economics & health services research

ESTRO 2024

Median age of patients was 49 years (IQR 26 - 72). There were 434 males (65%) and 236 females (35%). Astrocytic, oligodendroglial and primary intracranial ependymomas were seen in 550(82%), 97(14.5%) and 13(4.5%) patients respectively. Seizure at presentation was seen in 235/670 (35%) patients. Generalised tonic clonic seizures (200/670, 87%) predominated, while partial, focal or absence seizures were noted in 1.3%, 9.1% and 2.6% patients, respectively. Of the 235 patients who had seizures, 105 (44.7%) were IDH mutant, 86 (36.6%) were IDH wild-type and 34 (14.4%) patients had unknown IDH status because of poor quality paraffin blocks. Anticonvulsant drugs were prescribed in 658/670 patients (98.2%) in the perioperative period but continued for beyond 14 days irrespective of seizure-naive status at presentation. One anticonvulsant drug was used by 412 (62.6%)patients, 2 anticonvulsant drugs by 207 (31.4%)patients. Thirty-three(5%) patients had 3 anticonvulsants and 6 (0.9%) patients received 4 anticonvulsants at any point of their treatment and natural course of disease progression. Levetiracetam was the most commonly prescribed anticonvulsant drug, which was prescribed to 590 patients(88%) with a median daily dose of 1000mg. Other anticonvulsants which were prescribed were phenytoin, sodium valproate, clobazam and lacosamide, which were used by 169(25.7%), 33(5%), 65(9.8%) and 62(9.4%) patients respectively. None of the patients received anticonvulsants for prolonging progression free survival [PFS].

Mean annual cost of anticonvulsant medications to patients was INR 12,675 [$152.14], with a median of INR 9314 [$111.4] (IQR INR 9314 [$111.4] to INR 14923 [$179.12]).

Conclusion:

Irrespective of seizure status at presentation or its trajectory during the natural history of treatment and tumour control, long term usage of anticonvulsant drugs is high in our clinical practice. Only 1.2% of our patients met the SNO-EANO recommendation causing a significant financial burden to our patients and their families. This warrants a remedial anticonvulsant drug prescription writing policy for our neuro oncology practice to align to current guidelines and optimise seizure control and costs.

Keywords: tumour-related-epilepsy, glioma, anticonvulsants

References:

1. Vecht CJ, van Breemen M. Optimizing therapy of seizures in patients with brain tumors. Neurology. 2006 Dec 26;67(12 suppl 4):S10.

2. van Breemen MS, Wilms EB, Vecht CJ. Epilepsy in patients with brain tumours: epidemiology, mechanisms, and management. The Lancet Neurology. 2007 May;6(5):421 – 30.

3. Vecht CJ, Kerkhof M, Duran-Pena A. Seizure Prognosis in Brain Tumors: New Insights and Evidence-Based Management. The Oncologist. 2014 Jul 1;19(7):751 – 9.

4. Walbert T, Harrison RA, Schiff D, Avila EK, Chen M, Kandula P, et al. SNO and EANO practice guideline update: Anticonvulsant prophylaxis in patients with newly diagnosed brain tumors. Neuro-Oncology. 2021 Nov 2;23(11):1835 – 44.