Successful Treatment of Meningioma With Octreotide

Rünzi, Michael; Jaspers, C; Windeck, R.; Benker, G.; Mehdorn, H. M.; Reinhardt, V.; Reinwein, D.

doi:10.1016/s0140-6736(89)92465-3

Cited by 22 publications

(13 citation statements)

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“…Although the antitumoral effect of octreotide has been described in isolated cases of meningiomas, 18,21,38,40 only 4 clinical studies have aimed to assess this question (Table 2). 10,23,42,45 Three trials were performed on patients with aggressive and recurrent meningiomas, while 1 trial was conducted on patients with WHO Grade I skull base meningiomas who had not received prior radiotherapy or chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

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Octreotide therapy in meningiomas: in vitro study, clinical correlation, and literature review

Graillon

Reverter

Defilles

et al. 2017

Journal of Neurosurgery

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OBJECTIVE Meningiomas express somatostatin receptor subtype 2 (SST2), which is targeted by the somatostatin analog octreotide. However, to date, using somatostatin analog therapy for the treatment of these tumors in clinical practice has been debated. This study aims to clarify the in vitro effects of octreotide on meningiomas for precise clinical applications. METHODS The effects of octreotide were analyzed in a large series of 80 meningiomas, including 31 World Health Organization (WHO) Grade II and 4 WHO Grade III tumors, using fresh primary cell cultures to study the impact on cell viability, apoptosis, and signal transduction pathways. RESULTS SST2 mRNA was detected in 100% of the tested meningiomas at levels similar to those observed in other SST2-expressing tumors, neuroendocrine tumors, or pituitary adenomas. Octreotide significantly decreased cell proliferation in 88% of meningiomas but did not induce cell death. On average, cell proliferation was more inhibited in the meningioma group expressing a high level of SST2 than in the low-SST2 group. Moreover, octreotide response was positively correlated to the level of merlin protein and inversely correlated to the level of phosphorylated p70-S6 kinase, a downstream effector of the PI3K/Akt/mammalian target of rapamycin (mTOR) pathway. Octreotide inhibited Akt phosphorylation and activated tyrosine phosphatase without impacting the extracellular regulated kinase (ERK) pathway. CONCLUSIONS Octreotide acts exclusively as an antiproliferative agent and does not promote apoptosis in meningioma in vitro. Therefore, in vivo, octreotide is likely to limit tumor growth rather than induce tumor shrinkage. A meta-analysis of the literature reveals an interest in octreotide for the treatment of WHO Grade I tumors, particularly those in the skull base for which the 6-month progression-free survival level reached 92%. Moreover, somatostatin analogs, which are well-tolerated drugs, could be of interest for use as co-targeting therapies for aggressive meningiomas.

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Section: Discussionmentioning

confidence: 99%

“…Some clinical studies have analyzed octreotide efficacy in patients with meningioma, yet their conclusions remain disputed and are sometimes undefined. 10,17,18,21,23,38,40,42,45 Moreover, the results of octreotide treatment in meningioma cells in vitro have been contradictory. 4,26 Therefore, should we reject octreotide for meningioma therapy?…”

mentioning

confidence: 99%

Octreotide therapy in meningiomas: in vitro study, clinical correlation, and literature review

Graillon

Reverter

Defilles

et al. 2017

Journal of Neurosurgery

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“…13 The first case reports concerning the obvious effect of SST on meningioma have been published since 1989. 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.…”

Section: Discussionmentioning

confidence: 99%

Treatment of unresectable skull base meningiomas with somatostatin analogs

Schulz¹,

Mathieu²,

Kunz³

et al. 2011

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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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“…Diese sehr hohe Sensitivität der Szintigrafie entspricht auch den Ergebnissen der Literatur [5,13]. Neben den Fallberichten von Rünzi et al [7,8], Jaffrain-Rea [14] und Garcia-Luna [15] gibt es bislang nur die 16 Patienten umfassende Studie von Chamberlain et al [9], die mit einem sehr kurzen medianen Nachbeobachtungs-bzw. Therapiezeitraum ( …”

Section: Patienten Und Methodikunclassified

“…Chemotherapeutische Ansätze haben sich bisher nicht allgemeingültig durchgesetzt, obgleich es diverse Fallstudien mit unterschiedlichen Substanzen gab, wovon jedoch keine standardisiert eingesetzt wird [5,6]. Einzelfallberichte über wachstumshemmende Effekte von Somatostatin-Analoga (SST-A) auf intrakranielle Meningeome existieren bereits seit über 20 Jahren [7,8]. Ende 2007 wurde eine Untersuchung mit kurzem Follow-up-Intervall veröffentlicht, die bei 7 / 16 behandelten Patienten im 6-Monats-Intervall Progressionsfreiheit zeigen konnte [9].…”

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