Exp Clin Endocrinol Diabetes 2013; 121 - OP1_02
DOI: 10.1055/s-0033-1336610

Treatment with temozolomide in aggressive pituitary tumors – data from a survey by the German Pituitary Study Group

S Schlaffer 1, M Buchfelder 1, M Droste 2, U Elbelt 3, J Bojunga 4, J Flitsch 5, J Honegger 6, H Kolenda 7, A Lammert 8, R Buslei 9, W Saeger 10 S Petersenn 11, German Pituitary Study Group
  • 1University of Erlangen-Nuremberg, Department of Neurosurgery, Erlangen, Germany
  • 2Practice for Endocrinology and Diabetes, Oldenburg, Germany
  • 3Charité – Universitätsmedizin, Department of Endocrinology, Diabetes and Nutrition, Berlin, Germany
  • 4Johann Wolfgang Goethe-Universität, Dept of Internal Medicine I, Frankfurt, Germany
  • 5University Hospital Eppendorf, Department of Neurosurgery, Hamburg, Germany
  • 6University of Tuebingen, Department of Neurosurgery, Tuebingen, Germany
  • 7Diakoniekrankenhaus, Neurosurgery, Rotenburg, Germany
  • 8Universitätsmedizin Mannheim, Dept of Internal Medicine V, Mannheim, Germany
  • 9University of Erlangen-Nuremberg, Department of Neuropathology, Erlangen, Germany
  • 10Marienkrankenhaus, Institute of Pathology, Hamburg, Germany
  • 11ENDOC, Hamburg, Germany

Introduction: Patients with aggressive pituitary tumors still present a major challenge due to limited efficacy of surgery and radiotherapy, and the absence of any effective chemotherapy. Recently, temozolomide has been suggested as a potential treatment.

Methods: The German Pituitary Study group performed a survey, collecting data from patients treated with TMZ between 2009 and 2012. Inclusion critera were progressive pituitary tumor disease with MRI documentation. The primary end point was the objective tumor response rate. After chemotherapy, patients were followed up until progression. Results are presented as median (range).

Results: Eighteen patients (9 males, 54 (24 – 78) years with aggressive pituitary tumors (1 ACTH, 2 ACTH-Ca, 6 Nelson, 5 NFA, 1 NFA-Ca, 1 PRL, 2 PRL-Ca) received temozolomide (TMZ, 75 – 200 mg/m2) for 6 (1 – 12) cycles. All patients had been operated (4.5 (1 – 7) times) prior to therapy. 16 patients had received at least one radiotherapy 79 (36 – 314) months before TMZ, and 5 patients received radiotherapy parallel to TMZ (1x for primary tumor, 4x for metastases). Concomitant treatment included somatostatin analogues in 2 patients, and dopamine agonist in 3 patients. MRIs performed after TMZ demonstrated regression in 6 patients (33%) for at least 5 to 24 months, stabilization in 4 patients (22%) lasting for 12 months, and progression in 8 (44%) patients. The median progression free survival was 6 months (range 3 – 24 months). MGMT methylation status was available in 11 patients (2 positive, 9 negative), but did not help to predict tumor response (positive in 1 progressive and 1 stable tumor). Side effects included thrombocytopenia in 3 and neutropenia in one patient, respectively, the latter one leading to abandonment of therapy.

Conclusion: TMZ present an additional treatment option in patients with aggressive pituitary tumors, slowing progression in 56% of patients. MGMT methylation status did not help to predict tumor response.