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. © 2020, Springer Science+Business Media, LLC, part of Springer Nature.
Original language | English |
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Pages (from-to) | 359-366 |
Number of pages | 8 |
Journal | Pituitary |
Volume | 23 |
Issue number | 4 |
DOIs | |
Publication status | Published - 2020 |
Keywords
- Aggressive pituitary adenoma
- PitNETs
- Pituitary carcinoma
- Pituitary tumors
- Temozolomide
- temozolomide
- adult
- aged
- aggressive pituitary adenoma
- Article
- cancer chemotherapy
- clinical article
- female
- human
- hypophysis adenoma
- long term care
- male
- multiple cycle treatment
- priority journal
- retrospective study