Development of a meningioma in a patient with acromegaly during octreotide treatment: Are there any causal relationships?

Menis, Ernesto De; Tulipano, Giovanni; Villa, S.; Billeci, Domenico; Bonfanti, Carlo; Pollara, P.; Pauletto, Paolo; Giustina, Andrea

doi:10.1007/bf03345185

Cited by 17 publications

(14 citation statements)

References 26 publications

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“…7,26,27 One report showed rapid clinical improvement in patients on octreotide, although no radiological signs of tumor regression were detected. 10 In contrast, De Menis et al 5 documented the growth of a meningioma during treatment with octreotide for acromegaly. Octreotide effectively suppressed growth hormone secretion but could have stimulated the growth of the tentorium meningioma since SST did not significantly influence the in vitro proliferation of the patient's cultured tumor cells.…”

Section: Discussionmentioning

confidence: 98%

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Treatment of unresectable skull base meningiomas with somatostatin analogs

Schulz¹,

Mathieu²,

Kunz³

et al. 2011

FOC

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Object The standard surgical treatment for meningiomas is total resection, but the complete removal of skull base meningiomas can be difficult for several reasons. Thus, the management of certain meningiomas of the skull base—for example, those involving basal vessels and cranial nerves—remains a challenge. In recent reports it has been suggested that somatostatin (SST) administration can cause growth inhibition of unresectable and recurrent meningiomas. The application of SST and its analogs is not routinely integrated into standard treatment strategies for meningiomas, and clinical studies proving growth-inhibiting effects do not exist. The authors report on their experience using octreotide in patients with recurrent or unresectable meningiomas of the skull base. Methods Between January 1996 and December 2010, 13 patients harboring a progressive residual meningioma (as indicated by MR imaging criteria) following operative therapy were treated with a monthly injection of the SST analog octreotide (Sandostatin LAR [long-acting repeatable] 30 mg, Novartis). Eight of 13 patients had a meningioma of the skull base and were analyzed in the present study. Postoperative tumor enlargement was documented in all patients on MR images obtained before the initiation of SST therapy. All tumors were benign. No patient received radiation or chemotherapy before treatment with SST. The growth of residual tumor was monitored by MR imaging every 12 months. Results Three of the 8 patients had undergone surgical treatment once; 3, 2 times; and 2, 3 times. The mean time after the last meningioma operation (before starting SST treatment) and tumor enlargement as indicated by MR imaging criteria was 24 months. A total of 643 monthly cycles of Sandostatin LAR were administered. Five of the 8 patients were on SST continuously and stabilized disease was documented on MR images obtained in these patients during treatment (median 115 months, range 48–180 months). Three of the 8 patients interrupted treatment: after 60 months in 1 case because of tumor progression, after 36 months in 1 case because of side effects, and after 36 months in 1 case because the health insurance company denied cost absorption. Conclusions Although no case of tumor regression was detected on MR imaging, the study results indicated that SST analogs can arrest the progression of unresectable or recurrent benign meningiomas of the skull base in some patients. It remains to be determined whether a controlled prospective clinical trial would be useful.

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Section: Discussionmentioning

confidence: 98%

“…5,22 About 88% of the meningiomas analyzed (37 of 42 lesions) were positive for at least 1 of the 5 SSTR subtypes, displaying a variable pattern of mRNA expression of the different SSTR subtypes. 2 Messenger RNA from SSTRs 1 and 2 was the most frequently detected, and in half of the meningioma cells 3 or more SSTRs were detected.…”

Section: Discussionmentioning

confidence: 99%

Treatment of unresectable skull base meningiomas with somatostatin analogs

Schulz¹,

Mathieu²,

Kunz³

et al. 2011

FOC

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“…Similarly scattered case reports exist describing various tumors including brain tumors [112][113][114], osseous tumors [115], skin epidermoid tumors and melanomas [116], adrenal tumors [117][118][119][120], and different lymphohematopietic neoplasms (lymphoma, multiple myeloma, chronic myeloid or lymphocytic leukemia) [121][122][123].…”

Section: Other Tumorsmentioning

confidence: 96%

Acromegaly: Re-thinking the cancer risk

Loeper

Ezzat

2007

Rev Endocr Metab Disord

114

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Acromegaly is characterized by sustained elevation of circulating growth hormone (GH) and insulin-like growth factor I (IGF-I), and is clearly associated with increased morbidity and overall mortality mainly due to cardiovascular, metabolic, and respiratory diseases. Although cancer-related mortality varies widely amongst retroperspective studies, it appears to be consistently elevated mainly in patients with uncontrolled disease. We review individual tumor types including neoplasms of the colon, breast, prostate, and thyroid where in vitro, animal studies, and studies in non-acromegalic cancer patients have established a role for the GH/IGF-I axis in tumor progression and possibly initiation. We highlight deficiencies in data in acromegalic patients where the evidence is less convincing. Instead, we explore the hypothesis that acromegaly, independent of hormone secretion, is a disease that heralds genetic and/or epigenetic alterations predisposing to cancer risk elsewhere.

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“…in ovarian carcinoma [17, 53] and peritoneal metastases of colorectal carcinomas [18] targeting αvβ3-integrin or folate receptor α and VEGF-α, respectively. For the development of a similar approach in meningioma surgery, various biomarkers have been suggested, including epithelial membrane antigen (EMA), platelet-derived growth factor beta (PDGF-β), vascular endothelial growth factor A (VEGF-α), and somatostatin receptor type 2 (SSTR-2) [3, 5, 9, 11, 12, 16, 19, 21, 28, 30, 32, 38, 39, 43–45, 48, 52, 56]. However, the suitability of these markers for fluorescence-guided imaging meningioma surgery has not yet been investigated.…”

Section: Introductionmentioning

confidence: 99%

SSTR-2 as a potential tumour-specific marker for fluorescence-guided meningioma surgery

et al. 2018

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BackgroundMeningiomas are the most frequently occurring primary intracranial tumours in adults. Surgical removal can only be curative by complete resection; however surgical access can be challenging due to anatomical localization and local invasion of bone and soft tissues. Several intraoperative techniques have been tried to improve surgical resection, including intraoperative fluorescence guided imaging; however, no meningioma-specific (fluorescent) targeting has been developed yet. Here, we aimed to identify the most promising biomarkers for targeted intra-operative fluorescence guided meningioma surgery.MethodsOne hundred forty-eight meningioma specimens representing all meningioma grades were analysed using immunohistochemistry (IHC) on tissue microarrays (TMAs) to determine expression patterns of meningioma biomarkers epithelial membrane antigen (EMA), platelet-derived growth factor β (PDGF-β), vascular endothelial growth factor α (VEGF-α), and somatostatin receptor type 2 (SSTR-2). Subsequently, the most promising biomarker was selected based on TArget Selection Criteria (TASC). Marker expression was examined by IHC in 3D cell culture models generated from freshly resected tumour material.ResultsTMA-IHC showed strongest staining for SSTR-2. All cases were positive, with 51.4% strong/diffuse, 30.4% moderate/diffuse and only 18.2% focal/weak staining patterns. All tested biomarkers showed at least weak positivity in all meningiomas, regardless of WHO grade. TASC analysis showed that SSTR-2 was the most promising target for fluorescence guided imaging, with a total score of 21 (out of 22). SSTR-2 expression was determined on original patient tumours and 3D cultures of three established cultures.ConclusionsSSTR-2 expression was highly sensitive and specific in all 148 meningiomas, regardless of WHO grade. According to TASC analysis, SSTR-2 is the most promising receptor for meningioma targeting. After establishing in vitro meningioma models, SSTR-2 cell membrane expression was confirmed in two of three meningioma cultures as well. This indicates that specific fluorescence in an experimental setting can be performed for the further development of targeted fluorescence guided meningioma surgery and near-infrared fluorescent tracers targeting SSTR-2.

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Development of a meningioma in a patient with acromegaly during octreotide treatment: Are there any causal relationships?

Cited by 17 publications

References 26 publications

Treatment of unresectable skull base meningiomas with somatostatin analogs

Treatment of unresectable skull base meningiomas with somatostatin analogs

Acromegaly: Re-thinking the cancer risk

SSTR-2 as a potential tumour-specific marker for fluorescence-guided meningioma surgery

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