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Randomized Controlled Trial
. 2013 Oct;15(10):1429-37.
doi: 10.1093/neuonc/not114. Epub 2013 Aug 16.

Memantine for the prevention of cognitive dysfunction in patients receiving whole-brain radiotherapy: a randomized, double-blind, placebo-controlled trial

Paul D Brown  1 , Stephanie Pugh, Nadia N Laack, Jeffrey S Wefel, Deepak Khuntia, Christina Meyers, Ali Choucair, Sherry Fox, John H Suh, David Roberge, Vivek Kavadi, Soren M Bentzen, Minesh P Mehta, Deborah Watkins-Bruner; Radiation Therapy Oncology Group (RTOG)
Affiliations
Randomized Controlled Trial

Memantine for the prevention of cognitive dysfunction in patients receiving whole-brain radiotherapy: a randomized, double-blind, placebo-controlled trial

Paul D Brown et al. Neuro Oncol. 2013 Oct.

Abstract

Background: To determine the protective effects of memantine on cognitive function in patients receiving whole-brain radiotherapy (WBRT).

Methods: Adult patients with brain metastases received WBRT and were randomized to receive placebo or memantine (20 mg/d), within 3 days of initiating radiotherapy for 24 weeks. Serial standardized tests of cognitive function were performed.

Results: Of 554 patients who were accrued, 508 were eligible. Grade 3 or 4 toxicities and study compliance were similar in the 2 arms. There was less decline in delayed recall in the memantine arm at 24 weeks (P = .059), but the difference was not statistically significant, possibly because there were only 149 analyzable patients at 24 weeks, resulting in only 35% statistical power. The memantine arm had significantly longer time to cognitive decline (hazard ratio 0.78, 95% confidence interval 0.62-0.99, P = .01); the probability of cognitive function failure at 24 weeks was 53.8% in the memantine arm and 64.9% in the placebo arm. Superior results were seen in the memantine arm for executive function at 8 (P = .008) and 16 weeks (P = .0041) and for processing speed (P = .0137) and delayed recognition (P = .0149) at 24 weeks.

Conclusions: Memantine was well tolerated and had a toxicity profile very similar to placebo. Although there was less decline in the primary endpoint of delayed recall at 24 weeks, this lacked statistical significance possibly due to significant patient loss. Overall, patients treated with memantine had better cognitive function over time; specifically, memantine delayed time to cognitive decline and reduced the rate of decline in memory, executive function, and processing speed in patients receiving WBRT. RTOG 0614, ClinicalTrials.gov number CT00566852.

Trial registration: ClinicalTrials.gov NCT00566852.

Keywords: brain metastases; cognition; memantine; neuroprotective agents; radiotherapy.

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Figures

Fig. 1.
Fig. 1.
Consolidated Standards of Reporting Trials (CONSORT) diagram.
Fig. 2.
Fig. 2.
Cumulative incidence of cognitive function failure according to treatment arm.
Fig. 3.
Fig. 3.
Kaplan–Meier estimates of progression-free survival (A) and overall survival (B) according to treatment arm.
See this image and copyright information in PMC

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