Regression Of A Glioblastoma Multiforme: Spontaneous Versus A Potential Antineoplastic Effect Of Dexamethasone And Levetiracetam.
Peddi, P., Ajit, N. E., Burighton, G. V., & El-Osta, H. (2016). Regression of a glioblastoma multiforme: spontaneous versus a potential antineoplastic effect of dexamethasone and levetiracetam. BMJ case reports, 2016, bcr2016217393. https://doi.org/10.1136/bcr-2016-217393
View Original Source →Abstract
Patients with grade IV astrocytoma or glioblastoma multiforme (GBM) have a median survival of <12 months, increased to 14.6 months by maximal safe resection with radiation and temozolamide. In the absence of chemotherapy, radiotherapy or chemoradiotherapy, spontaneous regression of GBM or regression while only being on dexamethasone (DEX) and levetiracetam (LEV) have seldom been reported. Here, we present a case of a patient who had significant regression of the GBM with DEX and LEV alone. In this study, we hypothesise a plausible antineoplastic role of DEX and or LEV in GBM and highlight molecular, preclinical and clinical studies supporting this role.
Case Details
Disease Location
Bifrontal glioblastoma multiforme
Personal Characteristics
55-year-old-male with medical history of right frontal lobe grade ii astrocytoma in 2000 status post radiation and long term remission. 2009 - new right frontal and temporal mass treated with po temozolamide till dec 2011 at which point medication was stopped due to fatigue. On close follow until 2013.
Clinical Characteristics
Initial history of astrocytoma, radiotherapy and recurrent lesion after which po chemo given till dec 2011, observation and follow up till jan2013 . In jan 2013, MRI showed bifrontal lesion suggestive of gbm. Refused surgery and lost to follow-up. Presented with with acute lethargy, confusion in march 2014. MRI showed bifrontal expansile mass with vasogenic edema -> started on IV dexamethasone and levetiracetam for seizure prophylaxis. Biopsy showed grade 4 astrocytoma/gbm. At 2 months: improved delirium, speech, brain MRI on day 57 revealed mild improvement, on day 99, brain MRI showed further reduction of frontal, parasagittal mass size. On day 120, he was started on concurrent tmz and radiation followed by the maintenance of tmz. 2016: patient continues to do well with brain MRI showing no signs of recurrence
Remission Characteristics
March 2014: diagnosis of bifrontal gbm presenting with acute symptoms of confusion, lethargy. Started on dexamethasone and keppra with improvement in symptoms and regression of size of tumor.
Treatment & Mechanisms
Proposed Remission Mechanisms
Authors hypothesize spontaneous regression vs possible effect of dexamethasone and/or antiepilepatientic levetiracetam on tumor cell proliferation. Tumor molecular profiling was also done showed defective DNA repair genes which may have played a role.
Clinical Treatment
Dexamethasone, levetiracetam, temozolamide (tmz)