Long-course temozolomide in aggressive pituitary adenoma: real-life experience in two tertiary care centers and review of the literature
Purpose Aggressive pituitary adenomas (APAs) and pituitary carcinomas (PCs) are challenging for their invasive nature, resistance to treatment and recurrences. Temozolomide (TMZ) is used with benefit and well-tolerated toxicity profile in APAs and PCs. In most studies patients received ≤ 12 cycles b...
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| Veröffentlicht in: | Pituitary 2020-08, Vol.23 (4), p.359-366 |
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| creator | Lizzul, Laura Lombardi, Giuseppe Barbot, Mattia Ceccato, Filippo Gardiman, Marina Paola Regazzo, Daniela Bellu, Luisa Mazza, Elena Losa, Marco Scaroni, Carla |
| description | Purpose
Aggressive pituitary adenomas (APAs) and pituitary carcinomas (PCs) are challenging for their invasive nature, resistance to treatment and recurrences. Temozolomide (TMZ) is used with benefit and well-tolerated toxicity profile in APAs and PCs. In most studies patients received ≤ 12 cycles but the best length of treatment is debated since other options after discontinuation are scarce and a second course is mainly unsuccessful.
Methods
We report outcomes of 8 patients with APAs and PCs treated with TMZ for more than 12 continuous cycles with a literature review. Data were retrospectively collected from Padua and Milan University Hospitals. TMZ was used as a single agent (150–200 p.o. mg/m2 daily, 5/28 days) for 14 to 45 cycles.
Results
Eight patients (7 M), 7 APAs and 1 PC. Previous treatments included neurosurgery and radiotherapy in all cases except two giant masses (ACTH-silent APA and prolactinoma). No patient had progression disease (PD) during long-term treatment nor toxicities. No one had complete response (CR) but four had partial response (PR). Four ACTH+ tumors maintained stable disease (SD) but the secretion pattern improved in all. After drug withdrawal, three had delayed PD (2 after 18 and one after 29 months, all ACTH+); two are still in SD.
Conclusions
TMZ may be useful and well-tolerated in APAs and PCs as a long-term therapy. PR appears within the first cycles with no escape throughout the treatment; most patients achieve SD. We suggest extended protocols particularly in responsive ACTH+ PAs and PCs, when further therapies may be unsuccessful. |
| doi_str_mv | 10.1007/s11102-020-01040-4 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2385274291</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2385274291</sourcerecordid><originalsourceid>FETCH-LOGICAL-c347t-552979548843a7cb11895d0611e9783d9c271486fc012cff55e357831749832f3</originalsourceid><addsrcrecordid>eNp9kc1OHDEQhK2IKBCSF-CAfOTi4PbPeoYbQuRHWimXRMrNMp6ejdGMvdgeCHmCPHYMCxw5ueX6qqTuIuQI-Cfg3JwWAOCCccEZB644U2_IAWgjmVFc7rVZdismFfzaJ-9LueaN4lK9I_tSCCkM7w_Iv3WKG-bTkgvSinP6m6Y0hwFpiNRtNhlLCbdIt6Euobp8T92AMc3ujGZ0E5vCiBT_bDEHjP7RVe9SS8o1PNDeZaQeY_so1MWhuW4D3tE00vob6RSa4OqS8QN5O7qp4Men95D8_Hz54-IrW3__8u3ifM28VKYyrUVveq26Tkln_BVA1-uBrwCwN50cei8MqG41eg7Cj6PWKHUTwKi-k2KUh-Rkl7vN6WbBUu0cisdpchHTUqyQnRZGiR4aKnaoz6mUjKPd5jC3rSxw-9CA3TVgWwP2sQGrmun4KX-5mnF4sTyfvAFyB5QmxQ1me92uH9vOr8X-B_tbkiU</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2385274291</pqid></control><display><type>article</type><title>Long-course temozolomide in aggressive pituitary adenoma: real-life experience in two tertiary care centers and review of the literature</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Lizzul, Laura ; Lombardi, Giuseppe ; Barbot, Mattia ; Ceccato, Filippo ; Gardiman, Marina Paola ; Regazzo, Daniela ; Bellu, Luisa ; Mazza, Elena ; Losa, Marco ; Scaroni, Carla</creator><creatorcontrib>Lizzul, Laura ; Lombardi, Giuseppe ; Barbot, Mattia ; Ceccato, Filippo ; Gardiman, Marina Paola ; Regazzo, Daniela ; Bellu, Luisa ; Mazza, Elena ; Losa, Marco ; Scaroni, Carla</creatorcontrib><description>Purpose
Aggressive pituitary adenomas (APAs) and pituitary carcinomas (PCs) are challenging for their invasive nature, resistance to treatment and recurrences. Temozolomide (TMZ) is used with benefit and well-tolerated toxicity profile in APAs and PCs. In most studies patients received ≤ 12 cycles but the best length of treatment is debated since other options after discontinuation are scarce and a second course is mainly unsuccessful.
Methods
We report outcomes of 8 patients with APAs and PCs treated with TMZ for more than 12 continuous cycles with a literature review. Data were retrospectively collected from Padua and Milan University Hospitals. TMZ was used as a single agent (150–200 p.o. mg/m2 daily, 5/28 days) for 14 to 45 cycles.
Results
Eight patients (7 M), 7 APAs and 1 PC. Previous treatments included neurosurgery and radiotherapy in all cases except two giant masses (ACTH-silent APA and prolactinoma). No patient had progression disease (PD) during long-term treatment nor toxicities. No one had complete response (CR) but four had partial response (PR). Four ACTH+ tumors maintained stable disease (SD) but the secretion pattern improved in all. After drug withdrawal, three had delayed PD (2 after 18 and one after 29 months, all ACTH+); two are still in SD.
Conclusions
TMZ may be useful and well-tolerated in APAs and PCs as a long-term therapy. PR appears within the first cycles with no escape throughout the treatment; most patients achieve SD. We suggest extended protocols particularly in responsive ACTH+ PAs and PCs, when further therapies may be unsuccessful.</description><identifier>ISSN: 1386-341X</identifier><identifier>EISSN: 1573-7403</identifier><identifier>DOI: 10.1007/s11102-020-01040-4</identifier><identifier>PMID: 32232709</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>ACTH-Secreting Pituitary Adenoma - drug therapy ; ACTH-Secreting Pituitary Adenoma - pathology ; Adenoma - drug therapy ; Adenoma - pathology ; Adult ; Aged ; Antineoplastic Agents, Alkylating - therapeutic use ; Carcinoma - drug therapy ; Carcinoma - pathology ; Chemotherapy, Adjuvant ; Duration of Therapy ; Endocrinology ; Female ; Human Physiology ; Humans ; Italy ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Neoplasm Recurrence, Local - drug therapy ; Neoplasm Recurrence, Local - pathology ; Neurosurgical Procedures ; Pituitary Neoplasms - drug therapy ; Pituitary Neoplasms - pathology ; Progression-Free Survival ; Prolactinoma - drug therapy ; Prolactinoma - pathology ; Radiosurgery ; Radiotherapy, Adjuvant ; Temozolomide - therapeutic use</subject><ispartof>Pituitary, 2020-08, Vol.23 (4), p.359-366</ispartof><rights>Springer Science+Business Media, LLC, part of Springer Nature 2020</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c347t-552979548843a7cb11895d0611e9783d9c271486fc012cff55e357831749832f3</citedby><cites>FETCH-LOGICAL-c347t-552979548843a7cb11895d0611e9783d9c271486fc012cff55e357831749832f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11102-020-01040-4$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11102-020-01040-4$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32232709$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lizzul, Laura</creatorcontrib><creatorcontrib>Lombardi, Giuseppe</creatorcontrib><creatorcontrib>Barbot, Mattia</creatorcontrib><creatorcontrib>Ceccato, Filippo</creatorcontrib><creatorcontrib>Gardiman, Marina Paola</creatorcontrib><creatorcontrib>Regazzo, Daniela</creatorcontrib><creatorcontrib>Bellu, Luisa</creatorcontrib><creatorcontrib>Mazza, Elena</creatorcontrib><creatorcontrib>Losa, Marco</creatorcontrib><creatorcontrib>Scaroni, Carla</creatorcontrib><title>Long-course temozolomide in aggressive pituitary adenoma: real-life experience in two tertiary care centers and review of the literature</title><title>Pituitary</title><addtitle>Pituitary</addtitle><addtitle>Pituitary</addtitle><description>Purpose
Aggressive pituitary adenomas (APAs) and pituitary carcinomas (PCs) are challenging for their invasive nature, resistance to treatment and recurrences. Temozolomide (TMZ) is used with benefit and well-tolerated toxicity profile in APAs and PCs. In most studies patients received ≤ 12 cycles but the best length of treatment is debated since other options after discontinuation are scarce and a second course is mainly unsuccessful.
Methods
We report outcomes of 8 patients with APAs and PCs treated with TMZ for more than 12 continuous cycles with a literature review. Data were retrospectively collected from Padua and Milan University Hospitals. TMZ was used as a single agent (150–200 p.o. mg/m2 daily, 5/28 days) for 14 to 45 cycles.
Results
Eight patients (7 M), 7 APAs and 1 PC. Previous treatments included neurosurgery and radiotherapy in all cases except two giant masses (ACTH-silent APA and prolactinoma). No patient had progression disease (PD) during long-term treatment nor toxicities. No one had complete response (CR) but four had partial response (PR). Four ACTH+ tumors maintained stable disease (SD) but the secretion pattern improved in all. After drug withdrawal, three had delayed PD (2 after 18 and one after 29 months, all ACTH+); two are still in SD.
Conclusions
TMZ may be useful and well-tolerated in APAs and PCs as a long-term therapy. PR appears within the first cycles with no escape throughout the treatment; most patients achieve SD. We suggest extended protocols particularly in responsive ACTH+ PAs and PCs, when further therapies may be unsuccessful.</description><subject>ACTH-Secreting Pituitary Adenoma - drug therapy</subject><subject>ACTH-Secreting Pituitary Adenoma - pathology</subject><subject>Adenoma - drug therapy</subject><subject>Adenoma - pathology</subject><subject>Adult</subject><subject>Aged</subject><subject>Antineoplastic Agents, Alkylating - therapeutic use</subject><subject>Carcinoma - drug therapy</subject><subject>Carcinoma - pathology</subject><subject>Chemotherapy, Adjuvant</subject><subject>Duration of Therapy</subject><subject>Endocrinology</subject><subject>Female</subject><subject>Human Physiology</subject><subject>Humans</subject><subject>Italy</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Neoplasm Recurrence, Local - drug therapy</subject><subject>Neoplasm Recurrence, Local - pathology</subject><subject>Neurosurgical Procedures</subject><subject>Pituitary Neoplasms - drug therapy</subject><subject>Pituitary Neoplasms - pathology</subject><subject>Progression-Free Survival</subject><subject>Prolactinoma - drug therapy</subject><subject>Prolactinoma - pathology</subject><subject>Radiosurgery</subject><subject>Radiotherapy, Adjuvant</subject><subject>Temozolomide - therapeutic use</subject><issn>1386-341X</issn><issn>1573-7403</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc1OHDEQhK2IKBCSF-CAfOTi4PbPeoYbQuRHWimXRMrNMp6ejdGMvdgeCHmCPHYMCxw5ueX6qqTuIuQI-Cfg3JwWAOCCccEZB644U2_IAWgjmVFc7rVZdismFfzaJ-9LueaN4lK9I_tSCCkM7w_Iv3WKG-bTkgvSinP6m6Y0hwFpiNRtNhlLCbdIt6Euobp8T92AMc3ujGZ0E5vCiBT_bDEHjP7RVe9SS8o1PNDeZaQeY_so1MWhuW4D3tE00vob6RSa4OqS8QN5O7qp4Men95D8_Hz54-IrW3__8u3ifM28VKYyrUVveq26Tkln_BVA1-uBrwCwN50cei8MqG41eg7Cj6PWKHUTwKi-k2KUh-Rkl7vN6WbBUu0cisdpchHTUqyQnRZGiR4aKnaoz6mUjKPd5jC3rSxw-9CA3TVgWwP2sQGrmun4KX-5mnF4sTyfvAFyB5QmxQ1me92uH9vOr8X-B_tbkiU</recordid><startdate>20200801</startdate><enddate>20200801</enddate><creator>Lizzul, Laura</creator><creator>Lombardi, Giuseppe</creator><creator>Barbot, Mattia</creator><creator>Ceccato, Filippo</creator><creator>Gardiman, Marina Paola</creator><creator>Regazzo, Daniela</creator><creator>Bellu, Luisa</creator><creator>Mazza, Elena</creator><creator>Losa, Marco</creator><creator>Scaroni, Carla</creator><general>Springer US</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20200801</creationdate><title>Long-course temozolomide in aggressive pituitary adenoma: real-life experience in two tertiary care centers and review of the literature</title><author>Lizzul, Laura ; Lombardi, Giuseppe ; Barbot, Mattia ; Ceccato, Filippo ; Gardiman, Marina Paola ; Regazzo, Daniela ; Bellu, Luisa ; Mazza, Elena ; Losa, Marco ; Scaroni, Carla</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c347t-552979548843a7cb11895d0611e9783d9c271486fc012cff55e357831749832f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>ACTH-Secreting Pituitary Adenoma - drug therapy</topic><topic>ACTH-Secreting Pituitary Adenoma - pathology</topic><topic>Adenoma - drug therapy</topic><topic>Adenoma - pathology</topic><topic>Adult</topic><topic>Aged</topic><topic>Antineoplastic Agents, Alkylating - therapeutic use</topic><topic>Carcinoma - drug therapy</topic><topic>Carcinoma - pathology</topic><topic>Chemotherapy, Adjuvant</topic><topic>Duration of Therapy</topic><topic>Endocrinology</topic><topic>Female</topic><topic>Human Physiology</topic><topic>Humans</topic><topic>Italy</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Neoplasm Recurrence, Local - drug therapy</topic><topic>Neoplasm Recurrence, Local - pathology</topic><topic>Neurosurgical Procedures</topic><topic>Pituitary Neoplasms - drug therapy</topic><topic>Pituitary Neoplasms - pathology</topic><topic>Progression-Free Survival</topic><topic>Prolactinoma - drug therapy</topic><topic>Prolactinoma - pathology</topic><topic>Radiosurgery</topic><topic>Radiotherapy, Adjuvant</topic><topic>Temozolomide - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lizzul, Laura</creatorcontrib><creatorcontrib>Lombardi, Giuseppe</creatorcontrib><creatorcontrib>Barbot, Mattia</creatorcontrib><creatorcontrib>Ceccato, Filippo</creatorcontrib><creatorcontrib>Gardiman, Marina Paola</creatorcontrib><creatorcontrib>Regazzo, Daniela</creatorcontrib><creatorcontrib>Bellu, Luisa</creatorcontrib><creatorcontrib>Mazza, Elena</creatorcontrib><creatorcontrib>Losa, Marco</creatorcontrib><creatorcontrib>Scaroni, Carla</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Pituitary</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lizzul, Laura</au><au>Lombardi, Giuseppe</au><au>Barbot, Mattia</au><au>Ceccato, Filippo</au><au>Gardiman, Marina Paola</au><au>Regazzo, Daniela</au><au>Bellu, Luisa</au><au>Mazza, Elena</au><au>Losa, Marco</au><au>Scaroni, Carla</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Long-course temozolomide in aggressive pituitary adenoma: real-life experience in two tertiary care centers and review of the literature</atitle><jtitle>Pituitary</jtitle><stitle>Pituitary</stitle><addtitle>Pituitary</addtitle><date>2020-08-01</date><risdate>2020</risdate><volume>23</volume><issue>4</issue><spage>359</spage><epage>366</epage><pages>359-366</pages><issn>1386-341X</issn><eissn>1573-7403</eissn><abstract>Purpose
Aggressive pituitary adenomas (APAs) and pituitary carcinomas (PCs) are challenging for their invasive nature, resistance to treatment and recurrences. Temozolomide (TMZ) is used with benefit and well-tolerated toxicity profile in APAs and PCs. In most studies patients received ≤ 12 cycles but the best length of treatment is debated since other options after discontinuation are scarce and a second course is mainly unsuccessful.
Methods
We report outcomes of 8 patients with APAs and PCs treated with TMZ for more than 12 continuous cycles with a literature review. Data were retrospectively collected from Padua and Milan University Hospitals. TMZ was used as a single agent (150–200 p.o. mg/m2 daily, 5/28 days) for 14 to 45 cycles.
Results
Eight patients (7 M), 7 APAs and 1 PC. Previous treatments included neurosurgery and radiotherapy in all cases except two giant masses (ACTH-silent APA and prolactinoma). No patient had progression disease (PD) during long-term treatment nor toxicities. No one had complete response (CR) but four had partial response (PR). Four ACTH+ tumors maintained stable disease (SD) but the secretion pattern improved in all. After drug withdrawal, three had delayed PD (2 after 18 and one after 29 months, all ACTH+); two are still in SD.
Conclusions
TMZ may be useful and well-tolerated in APAs and PCs as a long-term therapy. PR appears within the first cycles with no escape throughout the treatment; most patients achieve SD. We suggest extended protocols particularly in responsive ACTH+ PAs and PCs, when further therapies may be unsuccessful.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>32232709</pmid><doi>10.1007/s11102-020-01040-4</doi><tpages>8</tpages></addata></record> |
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| subjects | ACTH-Secreting Pituitary Adenoma - drug therapy ACTH-Secreting Pituitary Adenoma - pathology Adenoma - drug therapy Adenoma - pathology Adult Aged Antineoplastic Agents, Alkylating - therapeutic use Carcinoma - drug therapy Carcinoma - pathology Chemotherapy, Adjuvant Duration of Therapy Endocrinology Female Human Physiology Humans Italy Male Medicine Medicine & Public Health Middle Aged Neoplasm Recurrence, Local - drug therapy Neoplasm Recurrence, Local - pathology Neurosurgical Procedures Pituitary Neoplasms - drug therapy Pituitary Neoplasms - pathology Progression-Free Survival Prolactinoma - drug therapy Prolactinoma - pathology Radiosurgery Radiotherapy, Adjuvant Temozolomide - therapeutic use |
| title | Long-course temozolomide in aggressive pituitary adenoma: real-life experience in two tertiary care centers and review of the literature |
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