Abstracts

Rationale: Nausea and vomiting are frequent side effects in patients undergoing chemotherapy, often despite pretreatment with antiemetic medications. We have clinically observed that patients with a variety of brain tumors seemed to have less nausea on levetiracetam (LEV) than those on older antiepileptic drugs (AEDs). This retrospective study evaluates whether patients with high-grade gliomas taking LEV had less severe nausea as compared to patients not taking LEV. Methods: We reviewed the electronic medical records of 194 patients with glioblastoma multiforme who underwent radiation and adjuvant chemotherapy at the Brigham and Women’s Hospital/Dana-Farber Cancer Institute between 3/1/2000 and 8/31/2006. We analyzed the first two adjuvant cycles of treatment with respect to AED use and severity of nausea/vomiting. Patients were categorized as having: 1) no nausea or mild nausea; 2) significant nausea responsive to antiemetics; 3) nausea intractable to antiemetics. Chi-square test was used to determine difference between the two groups of patients in regard to the three outcome categories. Thereafter, categories 2 and 3 were merged to create two groups (no significant nausea vs significant nausea). A logistic regression was performed to determine whether LEV use, age, sex, dexamethasone administration, and usage of multiple chemotherapeutic agents were risk factors for significant nausea. Results: Of 86 patients on LEV, 4 reported significant nausea and only 1 reported intractable nausea. Of 108 patients not on LEV, 10 reported significant nausea and 8 reported intractable nausea. This indicated significantly less nausea in patients on LEV (p=0.048). Logistic regression revealed that LEV use was significantly associated with decreased nausea (p=0.02). The patient’s age, sex, dexamethasone coadministration, and concurrent use of multiple chemotherapeutic agents were not significant factors in determining nausea. Conclusions: This retrospective study shows that patients with brain tumors on LEV were less susceptible to chemotherapy-induced nausea than patients not taking LEV. The mechanism through which LEV exerts antiemetic properties has not yet been determined. LEV may inhibit high-voltage activated calcium currents; such currents have been found in the area postrema neurons. It may in addition antagonize non-NMDA glutaminergic transmissions, which has been shown to abolish vagally mediated emesis. Because of its effectiveness against seizures, good tolerability, and lack of interaction with chemotherapeutic drugs, LEV is now routinely used as a first line agent in patients with brain tumors at our institution. We report an unexpected benefit against nausea in this population.