A novel use of temozolomide in a patient with malignant prolactinoma

Byrne, Stephen T.; Karapetis, C.; Vrodos, Nick

doi:10.1016/j.jocn.2009.05.013

Cited by 34 publications

(19 citation statements)

References 12 publications

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“…19 Of the reported cases, 4 of 11 pituitary adenomas 11,14-16,23 and 4 of 6 pituitary carcinomas 10,13,14,25 that were responsive to temozolomide were the PRL-producing type (Tables 1 and 2), in keeping with the finding by McCormack et al that prolactinomas had a propensity for low-level MGMT expression compared with other tumors. 19 Also noteworthy is the study by Takeshita et al 24 of 7 invasive Crooke cell adenomas, a morphologic variant of corticotrophic adenomas; of these, 5 had low MGMT expression compared with 1 of 17 conventional ACTH-producing adenomas.…”

Section: Mgmt Immunoexpressionsupporting

confidence: 81%

“…These included tumor necrosis and hemorrhage, 15,23 tumor degenerative and cystic changes, 22 and tumor shrinkage. 2,10,11,14,[19][20][21]24 These changes could be observed as early as 2 months after the onset of temozolomide treatment.…”

Section: Morphologic Changesmentioning

confidence: 98%

“…To date, 6 patients with pituitary carcinomas have received treatment with temozolomide 10,[12][13][14]17,19,[23][24][25] (Table 1). These included 4 men and 2 women ages 26 to 77 years (mean, 49.8 years).…”

Section: Pituitary Carcinomasmentioning

confidence: 99%

“…Fully 10 more patients with pituitary adenomas have received treatment with temozolomide 2,10,11,14,19,20,22 (unpublished results), bringing the current total to 13 patients, including 9 men and 4 women ages 20 to 61 years (mean, 47.9 years) ( Table 2). Aside from 1 incidentally discovered tumor in a patient with concomitant glioblastoma multiforme, all tumors have been studied morphologically.…”

Section: Pituitary Adenomasmentioning

confidence: 99%

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Treatment of pituitary neoplasms with temozolomide

Syro

Ortíz

Scheithauer

et al. 2010

Cancer

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Temozolomide, an orally administered alkylating agent, is used to treat malignant gliomas. Recent reports also have documented its efficacy in the treatment of pituitary adenomas and carcinomas. Temozolomide methylates DNA and thereby exhibits an antitumor effect. O 6 -methylguanine-DNA methyltransferase (MGMT), a DNA repair enzyme, removes alkylating adducts induced by temozolomide, counteracting its effects. The authors of this review conducted a Medline database search regarding temozolomide in the treatment of pituitary tumors. Demographic characteristics, tumor types, and therapeutic responses were noted in all patients. Data regarding MGMT immunoexpression, which was documented in some studies, were correlated with information regarding clinical and radiologic responses. To date, there have been 19 reported cases of adenohypophyseal tumors treated with temozolomide, including 13 adenomas and 6 carcinomas. Ten of those 13 adenomas responded favorably, and 2 nonresponsive tumors had highlevel MGMT immunoexpression. All 6 carcinomas responded to therapy, but data regarding MGMT expression were available for only 3 patients, and each had low MGMT expression. In 2 adenomas, morphologic studies were performed both before and after the patients received temozolomide. The responsive tumor had necrosis, hemorrhage, fibrosis, and neuronal differentiation. The nonresponsive tumor had no changes. There have been no reported complications attributable to temozolomide. The current results indicated that temozolomide is efficacious in the treatment of aggressive pituitary adenomas and pituitary carcinomas. Evidence indicated that low-level MGMT immunoexpression is correlated with a favorable response. A significant proportion of pituitary adenomas and carcinomas had low MGMT immunoexpression. Cancer 2011;117:454-62.

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Section: Mgmt Immunoexpressionsupporting

confidence: 81%

Section: Morphologic Changesmentioning

confidence: 98%

Section: Pituitary Carcinomasmentioning

confidence: 99%

Section: Pituitary Adenomasmentioning

confidence: 99%

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Treatment of pituitary neoplasms with temozolomide

Syro

Ortíz

Scheithauer

et al. 2010

Cancer

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“…14 For prolactinomas that are resistant to conventional doses of dopamine agonists, high dose cabergoline (12 mg per week or more), surgery, and radiotherapy should be utilized or, if these fail, as in our patient, additional therapies should be used including temozolomide. 15,16 Pituitary carcinomas and NET can change their hormone expression profile, which in part depends on their grade of differentiation.…”

Section: Discussionmentioning

confidence: 99%

What causes a prolactinoma to be aggressive or to become a pituitary carcinoma?

Phillips¹,

East²,

French³

et al. 2012

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INTrODUcTION: Malignant prolactinoma is an exceedingly rare endocrine tumor and cannot be diagnosed on histological grounds alone. similarly to other neuroendocrine tumors such as pheochromocytoma, the mitoses index, Ki-67, p53, and others are utilized in helping understand whether a tumor is benign or malignant or to better predict tumor behavior. We here present the unusual case of an unfortunate young man with an aggressive prolactinoma, the complications of which led to his premature death. cAsE rEPOrT: A 25-year-old white man developed severe headaches, low energy, and decreased libido. A brain magnetic resonance imaging (MrI) showed a 4 x 3 x 2 cm pituitary tumor invading the left cavernous sinus. Laboratory findings revealed elevated prolactin (470 ng/mL) and adrenocorticotropic hormone (AcTH, 82 pg/ml) and decreased total testosterone (176 ng/dl). Visual fields showed superior quadrantanopia in the left eye. Transsphenoidal pituitary resection was undertaken. Pathology revealed a prolactinoma with atypical cells, diffuse p53 nuclear labeling, and a Ki-67 index of 23% (high). Postoperatively, prolactin remained elevated (725-891 ng/ml) and cabergoline was increased to 1 mg three times weekly, with serum prolactin further increasing to 3507 ng/ml five months postoperatively. repeat MrI revealed extension of the tumor with optic chiasm compression and left orbit invasion. Because of acute left vision loss with ophthalmoplegia, an urgent left frontotemporal craniotomy and tumor resection were conducted. The Ki-67 index of the tumor was 24.8%, the mitotic figure immunostain phosphohistone-H3 positive. sixty percent (60%) of tumor cells were positive for p53. cabergoline was increased to 1 mg daily but prolactin remained elevated (770 ng/ml). The patient then underwent proton beam radiation to the area of concern involving the sella. Prolactin thereafter improved to 44 ng/ml. He then developed acute vision loss of the right eye with an MrI showing tumor in the right cavernous Case report HORMONES 2012, 11(4):477-482

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Cytotoxic Chemotherapy and Targeted Therapy for Aggressive Pituitary Tumors

Thomas

Fadul

2017

Transsphenoidal Surgery

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A novel use of temozolomide in a patient with malignant prolactinoma

Cited by 34 publications

References 12 publications

Treatment of pituitary neoplasms with temozolomide

Treatment of pituitary neoplasms with temozolomide

What causes a prolactinoma to be aggressive or to become a pituitary carcinoma?

Cytotoxic Chemotherapy and Targeted Therapy for Aggressive Pituitary Tumors

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