Objective: To evaluate the efficacy of perampanel (PER) over a period of 2 years and the usefulness of measuring blood levels during follow-up for patients with focal epilepsy.
Methods: A total of 46 patients with focal epilepsy (mean age: 24.7±9.3 years) were identified from medical records and their peak blood PER levels were measured. Of the 46 patients, 18 used enzyme inducers (carbamazepine, phenobarbital, phenytoin and topiramate) in combination with PER. Blood PER levels were measured immediately after reaching the PER maintenance dosage and 6 months, 1, 1.5, and 2 years later. The efficacy of PER was evaluated at the same time points as the blood sampling to determine the seizure reduction rate. The cases were then classified as effective (mean seizure reduction rates ≧50%) or ineffective (＜50%).
Results: The dosage and blood PER levels showed a positive correlation in cases of combination use without an inducer (r=0.388). However, no correlations were seen in all patients or in cases of combination use with an inducer (r=0.247, 0.326, respectively). In several groups, there was no positive correlations were seen between blood PER levels and efficacy. In all patients and cases of combination use with an inducer, significant differences were seen in the blood PER levels of effective vs. ineffective cases (p=0.041, 0.007, respectively). The optimal range was 500–530 ng/mL based on the mean and standard deviation in the effective cases. In the case of combination use, the range was 420–600 ng/mL.
Conclusion: We recommend an optimal range of PER as a therapeutic target as 500–600 ng/mL. Because this range is the common range of all patients and cases of combination use with an inducer.

Background: We normally perform axillary lymph node dissection (ALND) for breast cancer patients who are diagnosed with positive axillary lymph node metastasis (cN+), but there are quite a few patients whose axillary lymph node metastasis becomes pathological node negative (ypN0) after neoadjuvant chemotherapy (NAC). We hypothesized that we could possibly omit ALND if we accurately predicted ypN0. In this study we examined useful clinicopathological factors to predict ypN0 in cN+ breast cancer patients.
Method: A total of 278 patients with cN+ primary breast cancer who underwent NAC and ALND from January 2013 to December 2017 at St. Marianna University Hospital were included in this study. Using retrospective chart review, we assessed clinicopathological factors, accuracy of ypN0, and recurrence rate.
Results: Among 278 patients, 70.5% (196 patients) had clinical node negative (ycN0) after NAC, and the correct diagnostic rate (ypN0/ycN0) was 69.9%. the results of multivariate analysis showed that PgR-negative (OR 3.230, p=0.0189), HER2-positive (OR 3.323, p=0.0046), and clinical complete response (cCR) (OR 5.569, p=0.0032) were independently associated with ypN0. Although recurrence was observed in 21 patients (10.7%) of 196 ycN0 patients, there was no significant difference between the ypN+ (8.5%) and ypN0 (11.7%) groups (p=0.620).
Conclusion: In cN+ primary breast cancer patients who underwent NAC, PgR-negative, HER2-positive and cCR could be helpful predictive factors of ypN0 for safely omitting ALND.