A Case of Nonfunctioning Pituitary Carcinoma That Responded to Temozolomide Treatment

Morokuma, Haruko; Ando, Takao; Hayashida, Takuya; Horie, Ichiro; Inoshita, Naoko; Murata, Fumi; Ueki, Ikuko; Nakamura, K.; Imaizumi, Misa; Usa, Toshiro; Kawakami, Atsushi

doi:10.1155/2012/645914

Cited by 16 publications

(6 citation statements)

References 23 publications

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“…The standard treatment for PC is surgical resection, if feasible, and radiation therapy. Chemotherapy has been used, but overall response to classic agents is relatively poor [1,7]. However, more recently, TMZ-based chemotherapy regimens have shown encouraging antitumor activity [13,20–23].…”

Section: Discussionmentioning

confidence: 99%

“…A new proposed clinicopathological classification of pituitary tumors attempts to better predict the tumor biology by accounting for tumor size, immunocytochemical type, invasion and proliferation [6]. PC is typically resistant to therapy, with a median overall survival of only 31 months [1,7]. There is no standard treatment for PC, but maximal safe resection and radiation are performed when possible.…”

Section: Introductionmentioning

confidence: 99%

“…In recent years, encouraging preliminary data on the efficacy of temozolomide (TMZ)-based chemotherapy for NETs (including PC), alone or in combination with capecitabine, has been reported [7,9–13]. However, optimal schedule and duration of treatment have not been established.…”

Section: Introductionmentioning

confidence: 99%

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Radiotherapy with concurrent temozolomide for the management of extraneural metastases in pituitary carcinoma

et al. 2016

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Background Pituitary carcinomas (PC) are uncommon neuroendocrine tumors, accounting for 0.1% of all pituitary tumors. The diagnosis of PC is based on the presence of metastases from a pituitary adenoma, and not by local invasion or pathological features alone. PC is typically resistant to therapy, with a median overall survival (OS) of only 31 months. There is no standard treatment for PC, but maximal safe resection and radiation are performed when possible. Encouraging preliminary data on the use of temozolomide (TMZ)-based therapy has been previously reported. Methods We report the response to therapy and safety of radiation with concurrent temozolomide (RT/TMZ) in 2 adult patients with heavily pretreated PC and extraneural metastases. Results Both patients had prior history of pituitary macroadenoma. At the time of diagnosis of PC, Ki-67% was 24.2% and 10%, with positive p53 staining in one case. Metastatic sites included lymph nodes, liver and bone. Case-1 received RT/TMZ to the tumor bed in the skull base and to the metastases in the cervical lymph nodes. Case-2 received RT/TMZ to recurrent tumor involving portacaval lymph nodes. Both patients achieved excellent long-term control of the sites of treated extraneural metastases, with no significant acute or delayed toxicity. Conclusions RT/TMZ was safely delivered and might provide sustained control of extraneural metastases in PC. Although this retrospective report has limitations, RT/TMZ can be considered as a therapeutic option for the management of extraneural metastases in PC.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Radiotherapy with concurrent temozolomide for the management of extraneural metastases in pituitary carcinoma

et al. 2016

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“…Nevertheless, response to standard treatment is usually transient and PC recurrence is common ( Figs 1A and 1B), with a reported median overall survival (OS) of 1 year (1,6). Improved outcome has been recently reported with the use of chemotherapy in recurrent tumors (1,7), especially temozolomide (TMZ) (8,9,10,11,12,13,14,15,16,17,18) as a single agent, in combination with capecitabine (19) or concurrently with radiotherapy (20,21). Recent practice guidelines for the management of aggressive pituitary tumors and PC have recommended temozolomide as first-line chemotherapy, as well as management by expert multidisciplinary teams (22).…”

Section: Introductionmentioning

confidence: 99%

Treatment and long-term outcomes in pituitary carcinoma: a cohort study

Santos-Pinheiro

Penas‐Prado

Kamiya-Matsuoka

et al. 2019

European Journal of Endocrinology

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Background Pituitary carcinoma (PC) is an aggressive neuroendocrine tumor diagnosed when a pituitary adenoma (PA) becomes metastatic. PCs are typically resistant to therapy and develop multiple recurrences despite surgery, radiotherapy and chemotherapy. Recently, treatment with temozolomide (TMZ) has shown promising results, although the lack of prospective trials limits assessment of benefit. Methods We describe a single-center multidisciplinary experience in managing PC patients over a 22-year period and review previously published PC series. Results Seventeen patients were identified. Median age at PC diagnosis was 44 years (range 16–82 years), and the median time from PA to PC transformation was 5 years (range 1–29 years). Median follow-up time was 28 months. Most PCs were hormone-positive (n = 12): ACTH (n = 5), PRL (n = 4), LH/FSH (n = 2) and GH (n = 1). All patients underwent at least one resection and at least one course of radiation after PC diagnosis. Immunohistochemistry showed high Ki-67 labeling index (>3%) in 10/15 cases. Eight patients (47%) had only central nervous system (CNS) metastases; six (35%) had combined CNS and systemic metastases. The most commonly used chemotherapy was TMZ, and TMZ-based therapy was associated with the longest PFS in 12 (71%) cases, as well as the longest period from PC diagnosis to first progression (median 30 months). The 2, 3 and 5-year survival rate of the entire cohort was 71, 59 and 35%, respectively. All patients surviving >5 years had been treated with TMZ-based therapy. Conclusions PC management benefits from multidisciplinary care and multimodality therapy. TMZ-based regimens were associated with high survival rates and long disease control.

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“…Nevertheless, response to standard treatment is usually transient and PC recurrence is common, with a reported median overall survival (OS) of 1 year. 1, 6 Improved outcome has been recently reported with the use of chemotherapy in recurrent pituitary neuroendocrine tumors, 1, 7 especially temozolomide (TMZ) 8-18 as a single agent, in combination with capecitabine 19 or concurrently with radiotherapy 20, 21 . Recent practice guidelines for the management of aggressive pituitary tumors and PC have recommended temozolomide as first line chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

Pituitary carcinoma: The University of Texas MD Anderson Cancer Center experience

Santos-Pinheiro

Penas‐Prado

Kamiya-Matsuoka

et al. 2018

Preprint

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27Background: Pituitary carcinoma (PC) is an aggressive neuroendocrine tumor diagnosed when a pituitary 28 adenoma (PA) becomes metastatic. PCs are typically resistant to therapy and frequently recur. Recently, 29 treatment with temozolomide (TMZ) has shown promising results, although the lack of prospective trials 30 limits accurate assessment. Methods: We describe a single-center experience in managing PC over a [22][23][24][25][26][27][28][29][30][31] year period and review previously published PC series. Results: 17 patients were identified. Median age 32 at PC diagnosis was 44 years (range 16-82), and the median PA-to-PC conversion time was 5 years (range 33 1-29). Median follow-up was 28 months (range 8-158) with 7 deaths. Most PC were hormone-positive 34 based on immunohistochemistry (n=12): ACTH (n=5), PRL (n=4), LH/FSH (n=2), GH (n=1). All patients 35 underwent at least one resection and one course of radiation after PC diagnosis. Immunohistochemistry 36 showed high Ki-67 labeling index (>3%) in 10/15 cases. Eight patients (47%) had metastases only to the 37 CNS, and 6 (35%) had combined CNS and systemic metastases. The most commonly used chemotherapy 38 was TMZ, and TMZ-based therapy was associated with the longest period of disease control in 12 (71%) 39 cases, as well as the longest period from PC diagnosis to first progression in 8 (47%) cases. The 2, 3 and 40 5-year survival rate of the entire cohort was 71%, 59% and 35%, respectively. All patients surviving >5 41 years were treated with TMZ-based therapy. Conclusions: PC treatment requires a multidisciplinary 42 3 approach and multimodality therapy including surgery, radiation and chemotherapy. TMZ-based therapy 43 was associated with higher survival rates and longer disease control. 44 45 Precis 46 We describe 17 PC patients who were diagnosed and treated at MDACC over a 22-year period. 47

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A Case of Nonfunctioning Pituitary Carcinoma That Responded to Temozolomide Treatment

Cited by 16 publications

References 23 publications

Radiotherapy with concurrent temozolomide for the management of extraneural metastases in pituitary carcinoma

Radiotherapy with concurrent temozolomide for the management of extraneural metastases in pituitary carcinoma

Treatment and long-term outcomes in pituitary carcinoma: a cohort study

Pituitary carcinoma: The University of Texas MD Anderson Cancer Center experience

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