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A case of nonfunctioning pituitary carcinoma that responded to temozolomide treatment.

Morokuma H, Ando T, Hayashida T, Horie I, Inoshita N, Murata F, Ueki I, Nakamura K, Imaizumi M, Usa T, Kawakami A - Case Rep Endocrinol (2012)

Bottom Line: The patient received continuous dosing of TMZ along with external radiation, followed by standard dosing of TMZ.There was an apparent antitumor response seen in MRI.MGMT, an enzyme antagonized by TMZ, was negative in the tumor.

View Article: PubMed Central - PubMed

Affiliation: First Department of Medicine, Nagasaki University Graduates School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.

ABSTRACT
Pituitary carcinoma is a rare malignancy and is difficult to manage. Pituitary carcinomas commonly produce either PRL or ACTH, but some do not produce pituitary hormones. The alkylating reagent temozolomide (TMZ) was recently shown to be effective as a treatment for pituitary carcinoma. Most of the published reports of TMZ use in pituitary carcinoma cases were against hormone-producing carcinomas. Only a few patients with a nonfunctioning pituitary carcinoma treated with TMZ have been reported. Here we describe our treatment of a patient with nonfunctioning pituitary carcinoma and a background of multiple endocrine neoplasia type 1. The pituitary carcinoma was accompanied by meningeal dissemination with cerebral and L1 spinal bone metastasis. The patient received continuous dosing of TMZ along with external radiation, followed by standard dosing of TMZ. There was an apparent antitumor response seen in MRI. MGMT, an enzyme antagonized by TMZ, was negative in the tumor. The therapeutic efficacy of TMZ and dosing schedules of TMZ in pituitary carcinoma are discussed.

No MeSH data available.


Related in: MedlinePlus

The pituitary carcinoma after 12 cycles of treatment. The pituitary tumor is decreased and limited mostly within the sella (contrast-enhanced MRI). The left temporal lobe is not invaded by the tumor (a). The metastatic brain tumor in the occipital lobe grew smaller, without ringlike enhancement (b). The stalk was then identifiable (a and b). The meningeal dissemination regressed markedly (c). MGMT expression was negative in the pituitary tumor cells. MGMT was positive in the endothelial cells (arrow) and served as the internal positive control. MGMT staining was performed as described in [15].
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fig2: The pituitary carcinoma after 12 cycles of treatment. The pituitary tumor is decreased and limited mostly within the sella (contrast-enhanced MRI). The left temporal lobe is not invaded by the tumor (a). The metastatic brain tumor in the occipital lobe grew smaller, without ringlike enhancement (b). The stalk was then identifiable (a and b). The meningeal dissemination regressed markedly (c). MGMT expression was negative in the pituitary tumor cells. MGMT was positive in the endothelial cells (arrow) and served as the internal positive control. MGMT staining was performed as described in [15].

Mentions: After informed consent including a potential risk to the additional radiation to the whole brain was obtained from the patient and his family, TMZ (75 mg/mm2 per day for 42 days) was initiated along with total brain irradiation (30 Gy) as well as monthly zoledronic acid (4 mg). Adverse effects were only minor, that is, hair loss in the irradiated area and mild bone marrow suppression. Thus, we continued the TMZ (192 mg/mm2 for 5 days every 28 days) starting four weeks after the initial 42-day treatment was completed. The pituitary carcinoma visibly declined (Figure 2) and the patient's complaints of periorbital pain and occipital pain also decreased. There was an apparent decrease of the meningeal dissemination in the spine (not shown). The patient has completed 20 cycles of TMZ (192 mg/mm2 for 5 days every 28 days) with continuous clinical efficacy.


A case of nonfunctioning pituitary carcinoma that responded to temozolomide treatment.

Morokuma H, Ando T, Hayashida T, Horie I, Inoshita N, Murata F, Ueki I, Nakamura K, Imaizumi M, Usa T, Kawakami A - Case Rep Endocrinol (2012)

The pituitary carcinoma after 12 cycles of treatment. The pituitary tumor is decreased and limited mostly within the sella (contrast-enhanced MRI). The left temporal lobe is not invaded by the tumor (a). The metastatic brain tumor in the occipital lobe grew smaller, without ringlike enhancement (b). The stalk was then identifiable (a and b). The meningeal dissemination regressed markedly (c). MGMT expression was negative in the pituitary tumor cells. MGMT was positive in the endothelial cells (arrow) and served as the internal positive control. MGMT staining was performed as described in [15].
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3472534&req=5

fig2: The pituitary carcinoma after 12 cycles of treatment. The pituitary tumor is decreased and limited mostly within the sella (contrast-enhanced MRI). The left temporal lobe is not invaded by the tumor (a). The metastatic brain tumor in the occipital lobe grew smaller, without ringlike enhancement (b). The stalk was then identifiable (a and b). The meningeal dissemination regressed markedly (c). MGMT expression was negative in the pituitary tumor cells. MGMT was positive in the endothelial cells (arrow) and served as the internal positive control. MGMT staining was performed as described in [15].
Mentions: After informed consent including a potential risk to the additional radiation to the whole brain was obtained from the patient and his family, TMZ (75 mg/mm2 per day for 42 days) was initiated along with total brain irradiation (30 Gy) as well as monthly zoledronic acid (4 mg). Adverse effects were only minor, that is, hair loss in the irradiated area and mild bone marrow suppression. Thus, we continued the TMZ (192 mg/mm2 for 5 days every 28 days) starting four weeks after the initial 42-day treatment was completed. The pituitary carcinoma visibly declined (Figure 2) and the patient's complaints of periorbital pain and occipital pain also decreased. There was an apparent decrease of the meningeal dissemination in the spine (not shown). The patient has completed 20 cycles of TMZ (192 mg/mm2 for 5 days every 28 days) with continuous clinical efficacy.

Bottom Line: The patient received continuous dosing of TMZ along with external radiation, followed by standard dosing of TMZ.There was an apparent antitumor response seen in MRI.MGMT, an enzyme antagonized by TMZ, was negative in the tumor.

View Article: PubMed Central - PubMed

Affiliation: First Department of Medicine, Nagasaki University Graduates School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.

ABSTRACT
Pituitary carcinoma is a rare malignancy and is difficult to manage. Pituitary carcinomas commonly produce either PRL or ACTH, but some do not produce pituitary hormones. The alkylating reagent temozolomide (TMZ) was recently shown to be effective as a treatment for pituitary carcinoma. Most of the published reports of TMZ use in pituitary carcinoma cases were against hormone-producing carcinomas. Only a few patients with a nonfunctioning pituitary carcinoma treated with TMZ have been reported. Here we describe our treatment of a patient with nonfunctioning pituitary carcinoma and a background of multiple endocrine neoplasia type 1. The pituitary carcinoma was accompanied by meningeal dissemination with cerebral and L1 spinal bone metastasis. The patient received continuous dosing of TMZ along with external radiation, followed by standard dosing of TMZ. There was an apparent antitumor response seen in MRI. MGMT, an enzyme antagonized by TMZ, was negative in the tumor. The therapeutic efficacy of TMZ and dosing schedules of TMZ in pituitary carcinoma are discussed.

No MeSH data available.


Related in: MedlinePlus