Artikel
Imatinib mesylate (Glivec®) induces a durable partial response in a patient with esthesioneuroblastoma
Dauerhaftes partielles Ansprechen auf Imatinib mesylate (Glivec®) bei einem Patienten mit Esthesioneuroblastom
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Autoren
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K. Franz
- Klinik für Neurochirurgie, Universitätsklinikum Frankfurt/Main
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S. Krueger
- Klinik für Hämatologie und Onkologie, Universitätsklinikum Frankfurt/Main
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A. Kovacs
- Klinik für Mund-, Kiefer- und plastische Gesichtschirurgie, Universitätsklinikum Frankfurt/Main
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V. Seifert
- Klinik für Neurochirurgie, Universitätsklinikum Frankfurt/Main
| Veröffentlicht: | 8. Mai 2006 |
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Gliederung
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Objective: Treatment with imatinib mesylate can lead to a long-term stable disease in the rare but highly malignant disease of esthesioneuroblastoma. A 46-year-old man with heavily pretreated locally progredient esthesioneuroblastoma (olfactory neuroblastoma) is in stable partial response since 13 months on treatment with imatinib mesylate (Glivec®).
Methods: A 46-year-old man presented with a large frontobasal tumour infiltrating the lamina cribriformis, the right maxillary sinus and the right orbit. After resection in cooperation with the maxillofacial surgeon in 3/2000 revisions were necessary for pneumatocephalus and frontobasal cerebrospinal fluid fistula. The patient then received 3 cycles of Cisplatin and Etoposid and a fractionated three dimensional, intensity modulated radiotherapy of 59.4 Gy. Due to cervical lymphnode metastasis a percutaneous radiotherapy followed in Nov./Dec. 2001. Regular follow-up MRI examinations showed stable disease from September 2001 to March 2004. Due to recurrent tumour, partial resection of the maxilla had to be done. Three reoperations with partial resection of the maxilla and the zygomatic bone were necessary in the following months. In August 2004, tumour progression was again evident in MRI. Because of the presumably resulting severe facial mutilation from another surgical resection, systemic therapy was discussed.
Results: Second-line chemotherapy is not established for esthesioneuroblastoma. Based on limited, although encouraging results of imatinib therapy in other neurogenic tumours (Kilic, Cancer research 2000), we considered individual experimental therapy with this compound. Paraffin sections of the recent tumour resection were immunohistochemically partially positive for CD117. Thus, we supposed that imatinib therapy would be a feasible therapeutic option in our patient. He is now under treatment since 13 months without signs of recurrence in the regular MRI controls.
Conclusions: To our knowledge, this is the first report of successful treatment of esthesioneuroblastoma with imatinib mesylate. Patients with intensely and multimodally pretreated, locally recurrent, irresectable esthesioneuroblastoma may profit from imatinib mesylate therapy, which is able to induce persistent partial response and stabilization of disease in this rare malignancy.
