Stereotactic reirradiation with temozolomide in patients with recurrent aggressive pituitary tumors and pituitary carcinomas

Minniti, Giuseppe; Paolini, Sergio; Rea, M.; Isidori, Andrea M.; Scaringi, Claudia; Russo, Ivana; Osti, Mattia Falchetto; Cavallo, Luigi Maria; Esposito, Vincenzo

doi:10.1007/s11060-020-03579-5

Cited by 14 publications

(10 citation statements)

References 40 publications

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“…Combined treatment subsequently increases the toxicity, noteworthy, the TMZ-related adverse events for single medicine remain unchanged, which will not induce the dose delaying and discontinuation of TMZ (25). Therefore, the potential benefit of combined chemoradiotherapy is warranted in future prospective trials (15).…”

Section: Discussionmentioning

confidence: 99%

“…With the detailed screening of title and abstract, 85 studies were included as relevant studies for full-text screening. Of the full-text articles retrieved, 21 studies met the preset inclusion criteria (10)(11)(12)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31). Reference list of included studies and relevant reviews did not provide any additional studies.…”

Section: Identification Of Eligible Studymentioning

confidence: 99%

See 1 more Smart Citation

Clinical Efficacy of Temozolomide and Its Predictors in Aggressive Pituitary Tumors and Pituitary Carcinomas: A Systematic Review and Meta-Analysis

Luo¹,

Tan²,

Chen³

et al. 2021

Front. Neurol.

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Background: A growing number of evidences suggest that TMZ applications can generate impressive benefits for APT and PC patients. However, the definite role of TMZ for individuals remains unclarified due to the variation between studies. And the predictive factors to alter its efficacy remain debatable.Objective: To evaluate the long-term effectiveness and safety profile of TMZ in the treatment of pituitary malignancies, and delineate the predictors during its clinical employment.Results: A literature retrieval was conducted from online databases for studies published up to December 31, 2020. Twenty one studies involving 429 patients were identified. TMZ exhibited 41% radiological overall response rate (rORR). The biochemical response rate was determinate in 53% of the functioning subset. Two-year and 4-year survival rate were 79 and 61%, respectively. TMZ prolonged the median PFS and OS as 20.18 and 40.24 months. TMZ-related adverse events occurred in 19% of patients. Regarding predictors of TMZ response, rORR was dramatically improved in patients with low/intermediate MGMT expression than those with high-MGMT (>50%) (p < 0.001). The benefit of TMZ varied according to functioning subtype of patients, with greater antitumor activities in functioning subgroups and fewer activities in non-functioning sets (p < 0.001). Notably, the concomitant therapy of radiotherapy and TMZ significantly increased the rORR (p = 0.007).Conclusion: TMZ elicits clinical benefits with moderate adverse events in APT and PC patients. MGMT expression and clinical subtype of secreting function might be vital predictors of TMZ efficacy. In the future, the combination of radiotherapy with TMZ may further improve the clinical outcomes than TMZ monotherapy.

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Section: Discussionmentioning

confidence: 99%

Section: Identification Of Eligible Studymentioning

confidence: 99%

Clinical Efficacy of Temozolomide and Its Predictors in Aggressive Pituitary Tumors and Pituitary Carcinomas: A Systematic Review and Meta-Analysis

Luo¹,

Tan²,

Chen³

et al. 2021

Front. Neurol.

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“…This implies a synergistic effect of radiotherapy as described in glioblastomas (137) and was also observed in the large ESE survey of pituitary tumours (16). A recent Italian study (138) investigated the outcome of re-irradiation and concomitant TMZ in 21 patients with recurrent aggressive adenomas and carcinomas (14 with previous TMZ treatment). A complete response was seen in two and partial response in 11.…”

Section: Is Mgmt Associated With the Response To Temozolomide?mentioning

confidence: 65%

Cushing’s disease and aggressive pituitary tumours : Aspects on epidemiology, treatment, and long-term follow-up

Bengtsson

2021

Linköping University Medical Dissertations

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This thesis focuses on clinical and epidemiological aspects of aggressive pituitary tumours/carcinomas and Cushing's disease. Pituitary carcinomas account for only 0.1-0.2% of the tumours originating from the anterior pituitary gland and are defined solely by the event of distant metastases, whereas aggressive pituitary tumours are defined by their clinical behaviour of rapid/progressive growth despite optimal treatment with surgery, radiotherapy and medical agents. The prognosis for individuals with aggressive tumours/carcinomas has been poor with few treatment options. However, case reports indicated better outcomes after treatment with the alkylating agent temozolomide. In study I and III, we investigated 24 patients (16 aggressive tumours and 8 carcinomas) given treatment with temozolomide. We found an initial response rate (tumour regression ≥30%) in 10/21 evaluable patients, with complete regression in two carcinomas. Favourable response was associated with low tumour expression of the DNA repair protein MGMT; in responders median 9% (range 5-20%) vs non-responders median 93% (50-100%). Our results also indicated a longer survival in patients with low MGMT. Out of 11 patients with MGMT >10%, nine died with an estimated median survival of 26 months (95% CI 14-38), whereas only 1/6 patients with lower MGMT died from tumour progression during a follow-up of median 83 months (range 12-161).

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“…The underlying hypothesis is that concurrent temozolomide potentiates the effects of tumor radiation. Minniti et al investigated stereotactic radiotherapy combined with temozolomide in 21 patients with recurrent aggressive pituitary adenomas (n = 17) and carcinomas (n = 4) [14]. All patients had received prior fractionated radiotherapy or stereotactic radiosurgery, and 15 patients had received prior temozolomide therapy at a median time of 28 months before reirradiation.…”

Section: Introductionmentioning

confidence: 99%

“…CR complete remission, PR partial remission, SD stable disease, PD progressive disease. Data taken from references [12][13][14][38][39][40][41][42][43][44][45][46][47][48]. Details on the first 11 references are presented in a recent review [49].…”

Section: Introductionmentioning

confidence: 99%

Medical Therapy of Aggressive Pituitary Tumors

Petersenn¹

2021

Exp Clin Endocrinol Diabetes

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The rare aggressive pituitary adenoma presents a special challenge, due to the heterogenous presentation of the disease. The prognosis of aggressive pituitary adenomas has been improved due to recent studies demonstrating clinically-relevant efficacy of temozolomide, which is now considered first-line chemotherapy. However, there is limited data on second-line therapies in patients with treatment failure. This review presents a summary on the potential of medical therapies in aggressive pituitary tumors.

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Stereotactic reirradiation with temozolomide in patients with recurrent aggressive pituitary tumors and pituitary carcinomas

Cited by 14 publications

References 40 publications

Clinical Efficacy of Temozolomide and Its Predictors in Aggressive Pituitary Tumors and Pituitary Carcinomas: A Systematic Review and Meta-Analysis

Clinical Efficacy of Temozolomide and Its Predictors in Aggressive Pituitary Tumors and Pituitary Carcinomas: A Systematic Review and Meta-Analysis

Cushing’s disease and aggressive pituitary tumours : Aspects on epidemiology, treatment, and long-term follow-up

Medical Therapy of Aggressive Pituitary Tumors

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