Ependymoma Medication

Updated: Mar 09, 2023
  • Author: Jeffrey N Bruce, MD; Chief Editor: Herbert H Engelhard, III, MD, PhD, FACS, FAANS  more...
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Medication Summary

No specific medications exist to treat ependymomas. Conventional chemotherapeutic agents that have shown efficacy in other CNS neoplasms, such as temozolomide, have shown some promise in treating patients with recurrent ependymoma, but are not routinely recommended. [69]

However, there are a number of active clinical trials that are exploring the use of a variety of drug classes for their efficacy in ependymoma, particularly in pediatric patients with recurrent disease. Immunotherapies, tyrosine kinase inhibitors, and angiogenesis inhibitors have shown promising results in preclinical experiments, but have not demonstrated benefit in any clinical trials to date. [13]    

 While medications are not a central part of curative treatment for ependymoma, they play a role in managing associated symptoms. For seizure control in supratentorial ependymomas, patients are usually started on levetiracetam (Keppra), phenytoin (Dilantin), or carbamazepine (Tegretol). Levetiracetam is often used because it lacks the effects on the P450 system seen with phenytoin and carbamazepine, which can interfere with antineoplastic therapy. Vasogenic cerebral edema is treated with corticosteroids (eg, dexamethasone), generally in combination with an anti-ulcer agent. Corticosteroids also are effective to treat edema associated with intramedullary tumors in the preoperative and postoperative settings.



Class Summary

These agents are used to treat and to prevent seizures.

Levetiracetam (Keppra)

Used as adjunct therapy for partial seizures and myoclonic seizures. Also indicated for primary generalized tonic-clonic seizures. Mechanism of action is unknown.

Phenytoin (Dilantin)

Blocks sodium channels and prevents repetitive firing of action potentials. Effective anticonvulsant and first-line agent in treating partial and generalized tonic-clonic seizures.

Carbamazepine (Tegretol)

Like phenytoin, interacts with sodium channels and blocks repetitive neuronal firing. First-line agent to treat partial seizures and may be used for tonic-clonic seizures as well. Extended release form available, which is administered bid. Serum drug levels should be monitored (ideal range is 4-8 mcg/mL).



Class Summary

These agents reduce peritumoral edema, frequently leading to symptomatic and objective improvement.

Dexamethasone (Decadron)

Postulated mechanisms of action in brain tumors include reduction in vascular permeability, cytotoxic effects on tumors, inhibition of tumor formation, and decreased CSF production.