How effective is temozolomide for treating pituitary tumours and when should it be used?

Abstract

Temozolomide (TMZ) has been shown as an effective treatment option in aggressive pituitary adenomas and carcinomas. This review analyses the published case series and demonstrates 42 % of patents show a radiological response and 27 % experience stable disease following TMZ. Prolactinomas and corticotroph tumours respond best to TMZ, showing approximately a 50 % response rate, with non-functioning tumours responding only half as frequently. Other factors that may predict the tumour's TMZ response include MGMT and MSH status, but neither is sufficiently robust to determine treatment decisions. TMZ has an accepted role in treating pituitary carcinoma and adenomas if radiation and surgery have failed to control tumour growth. To use TMZ on the basis of anticipated future aggression, as a primary therapy, or in preference to radiotherapy remains controversial.

Temozolomide therapy for aggressive pituitary Crooke’s cells corticotropinoma causing Cushing’s Disease: A case report with literature review

“…In a series of 24 patients, Bengtsson et al reported a 46% response to the treatment: three patients having undergone a complete response, nine complete tumour regression, and in eight patients a partial regression was observed [15]. TMZ therapy resulted in stabilising the disease (total remission, partial remission, or lack of progression) in more than 60% of patients [4,[15][16][17]. Clinically functional tumours responded better than non-functioning ones, with up to a 50% response rate in prolactinomas and corticotroph tumours [4,[15][16][17].…”

“…TMZ therapy resulted in stabilising the disease (total remission, partial remission, or lack of progression) in more than 60% of patients [4,[15][16][17]. Clinically functional tumours responded better than non-functioning ones, with up to a 50% response rate in prolactinomas and corticotroph tumours [4,[15][16][17]. The results of the studies might be related to publication bias.…”

“…These reports were quickly followed by a number of case reports and a few studies on a series of patients. According to a review by Halevy and Whitelaw published in 2017, the overall response rate was 45% with a further 27% reporting stable disease [4]. In a series of 24 patients, Bengtsson et al reported a 46% response to the treatment: three patients having undergone a complete response, nine complete tumour regression, and in eight patients a partial regression was observed [15].…”

“…However, some pituitary tumours present as aggressive with rapid growth. They are usually invasive macroadenomas with a high recurrence rate, resistant to repeated treatments [1][2][3][4]. There is no clear definition of aggressive pituitary tumours.…”

“…There is growing evidence for the use of temozolomide (TZM) monotherapy as first-line chemotherapy. In 2017 Halevy and Whitelaw published a review of the literature regarding the effectiveness of TMZ in pituitary tumour treatment [4].…”