Artikel
Treatment with temozolomide in aggressive pituitary tumors – data from a survey by the German Pituitary Study Group
Suche in Medline nach
Autoren
-
Sven-Martin Schlaffer
- Neurochirurgische Klinik, Universitätsklinikum Erlangen
-
Michael Buchfelder
- Neurochirurgische Klinik, Universitätsklinikum Erlangen
-
Michael Droste
- Praxis für Endokrinologie und Diabetologie, Oldenburg
-
Uwe Elbelt
- Medizinische Klinik mit Schwerpunkt Endokrinologie, Diabetes und Ernährungsmedizin, Charité - Universitätsmedizin Berlin
-
Rolf Buslei
- Neuropathologisches Institut, Universitätsklinikum Erlangen
-
Stephan Petersenn
- ENDOC Center for Endocrine Tumors, Hamburg
| Veröffentlicht: | 21. Mai 2013 |
|---|
Gliederung
Text
Objective: Patients with aggressive pituitary tumors still present a major challenge due to limited efficacy of surgery and radiotherapy, and the absence of any effective chemotherapy. Recently, temozolomide (TMZ) has been suggested as a potential treatment.
Method: The German Pituitary Study group performed a survey, collecting data from patients treated with TMZ between 2008 and 2012. Inclusion criteria were progressive pituitary tumor disease with MRI documentation. The standard imaging procedure was MRI, and the primary end point was the objective tumor response rate. After chemotherapy, patients were followed up until progression. Results are presented as median (range).
Results: Eighteen patients (9 males) 54 (24–78) years old with aggressive pituitary tumors (1 ACTH, 2 ACTH-Ca, 6 Nelson, 5 NFA, 1 NFA-Ca, 1 PRL, 2 PRL-Ca) received TMZ (75–200mg/m2) for 6 (1–12) cycles. All patients had been operated 4.5 (1–7) times prior to therapy. 16 patients had received at least one radiotherapy 79 (36–314) months before TMZ, and 5 patients received radiotherapy parallel to TMZ (1x for primary tumor, 4x for metastases). Concomitant treatment included somatostatin analogues in 2 patients, and dopamine agonist in 3 patients. MRIs performed after TMZ demonstrated regression in 6 patients (33%) for at least 5 to 24 months, stabilization in 4 patients (22%) lasting for 12 months, and progression in 8 (44%) patients. The median progression free survival was 6 months (range 3–12 months). MGMT methylation status was available in 11 patients (2 positive, 9 negative), but did not help to predict tumor response (positive in 1 progressive and 1 stable tumor). Side effects included thrombocytopenia in 3 and neutropenia in one patient, respectively, the latter one leading to abandonment of therapy.
Conclusions: TMZ present an additional treatment option in patients with aggressive pituitary tumors, slowing progression in 56% of patients. MGMT methylation status did not help to predict tumor response.
