Failure of Gonadotropin Releasing Hormone Therapy in Patients with Metastatic Ovarian Sex Cord Stromal Tumors

Gl, Maxwell; Soisson, AP; Miles, Philip A.

doi:10.1159/000227365

Cited by 24 publications

(5 citation statements)

References 11 publications

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“…However, experience in treating GCT with hormonal agents is limited. Although several studies have reported the successful use of GnRH agonists (7, 8), negative results have also been reported (9). Furthermore, hormonal therapy has been attempted in cases of progressive GCTs that have failed to respond to chemotherapy and/or radiation.…”

Section: Discussionmentioning

confidence: 99%

GnRH Agonist Therapy in a Patient with Recurrent Ovarian Granulosa Cell Tumors

et al. 2009

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A 65-yr-old woman presented 17 yr status post-hysterectomy with bilateral ovarian salpingo-oophorectomy, attributable to ovarian cancer. She was admitted to our hospital, with multiple cystic liver masses and multiple large seeded masses in her abdomen and pelvic cavity. Histological examination of the pelvic masses demonstrated granulosa cell tumors. After two courses of systemic combination chemotherapy, with paclitaxel and carboplatin, the masses in the abdomen and pelvic cavity increased, and debulking surgery also failed because of peritoneal dissemination with severe adhesion. Finally, she underwent palliative radiotherapy for only the pelvic masses obstructing the urinary and GI tracts, and monthly hormonal therapy with a gonadotrophin-releasing hormone agonist; leuprorelin 3.75 mg IM. Subsequently, multiple masses beyond the range of the radiation as well as those within the radiotherapy field partially decreased. This partial response had been maintained for more than 8 months as of the last follow-up visit. Owing to its long and indolent course and the low metabolic rate of the tumors, advanced or recurrent granulosa cell tumor (GCT) requires treatment options beyond chemotherapy, surgery, and radiotherapy. Hormonal agents may provide another treatment option for advanced or recurrent GCT in those who are not candidates for surgery, chemotherapy, or radiotherapy.

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Section: Discussionmentioning

confidence: 99%

GnRH Agonist Therapy in a Patient with Recurrent Ovarian Granulosa Cell Tumors

et al. 2009

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“…Kim et al [75] have described PR with monthly GnRH agonists (leuprolide acetate 3.75 mg IM) lasting 3-11 months. A few other studies have shown response to GnRH agonists [73,74,77] while others showed no response to agonists and GnRH antagonists [78,79].…”

Section: Recurrent Gctmentioning

confidence: 99%

Recent Advances in Granulosa Cell Tumor Ovary: A Review

Kottarathil

Antony

Nair

et al. 2012

Indian J Surg Oncol

106

108

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Granulosa cell tumors constitute less than 5 % of all ovarian tumors. Unlike epithelial ovarian tumors, they occur in a younger age group, are usually detected in an early stage and often have features of hyperestrogenism. The presenting symptoms are usually nonspecific with abdominal pain or distension. They follow an indolent course and are characterized by a long natural history. Mutation of FOXL2 (402C->G) seen in 97 % of adult GCT may be pathognomonic for adult GCT. Only stage of the disease has been consistently shown in various studies to affect survival of patients with GCT. The initial management of patients, for whom fertility is not an issue, is total abdominal hysterectomy, bilateral salpingo-oophorectomy and removal of all gross disease. Nodal dissection is not a significant factor for survival and is not recommended in surgical staging of GCT. Fertility preserving surgery with unilateral salpingooophorectomy is feasible in young patients with stage Ia GCT. Patients with early stage disease (stage I and II) have a very good prognosis with 5 year DFS and OS of 89 % and 99 % respectively and these groups of patients usually don't require any postoperative treatment. Patients with stage Ic disease associated with poor prognostic factors like large tumor size or high mitotic index and stage II, have a higher chance of relapse, and may benefit with postoperative treatment but role of chemotherapy is still debatable. In advanced stage disease (stage III and IV) the 5 year DFS and OS disease was 72 % and 80 % respectively hence the option of postoperative treatment with 6 cycles of BEP should be considered in this group. Recently paclitaxel is being investigated as an effective tool in GCT. The efficacy of radiation in GCT is not well defined but in optimally debulked cases postoperative radiation is a viable option. Due to high chance of recurrence even years after apparent clinical cure of the primary tumor, lifelong follow up with clinical examination and tumor markers like inhibin B is recommended. About 25 % GCT develop recurrence and the median time to recur is usually 4-5 years. Most recurrences are intraperitoneal and usually a complete debulking of the disease is feasible even in the recurrent setting. Postoperative chemotherapy (platinum based) is usually given after surgery more so in cases with widespread disease or after suboptimal cytoreduction. Recurrent chemoresistant, progressive non-responding GCT or patients with high surgical risk are ideal candidates for targeted therapy.

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“…However, their possible use in the management of cancers in castrated or menopausal individuals, where they would turn into decreased gonadotrophin levels, has never been studied, as the rationale for this is currently missing. Similarly, clinical trials investigating gonadotrophin suppression for the treatment of rare, gonadotrophin-sensitive cancers, such as ovarian granulosa cell tumors, have been scanty and contradictory(Fishman, Kudelka, Tresukosol et al, 1996,Maxwell, Soisson andMiles, 1994). Thus, it is important to further characterize the biology of gonadotrophins and of their receptors in the setting of cancer.…”

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confidence: 99%