Temozolomide Therapy in Management of Refractory Pituitary Adenomas: A Case Series of 39 Patients.

IF 3.7 3区医学 Q2 ENDOCRINOLOGY & METABOLISM Endocrine Practice Pub Date : 2024-10-22 DOI:10.1016/j.eprac.2024.10.008

Xiaohai Liu, Congxin Dai, Chenxin Tian, Xinjie Bao, Kan Deng, Yong Yao, Yiguang Chen, Mingchu Li, Ge Chen, Ming Feng, Renzhi Wang

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Abstract

Objective: The management of refractory pituitary adenomas (RPAs) presents significant challenges. This study aimed to evaluate the long-term treatment outcomes of patients with RPA managed with temozolomide (TMZ) and to identify potential biomarkers for predicting TMZ treatment response.

Methods: This retrospective case series included patients with RPA who underwent trans-sphenoidal surgery (TSS) or craniotomy at a comprehensive medical center in China between January 2014 and December 2021.

Results: 39 patients with RPA (median age 42 years; 23 males [59%]) were treated with TMZ for a median of 9 cycles. The median follow-up was 34.4 months. Complete response (CR) was observed in 2 patients, partial response (PR) in 11 patients, stable disease (SD) in 9, progressive disease (PD) in 11, and death in 6 patients. O6-methylguanine DNA methyltransferase levels were significantly lower in patients with CR, PR, or SD compared to those with PD or mortality, with mean values of 24.2% and 58.1, respectively. MutS homologs 6 levels were significantly higher in patients with CR, PR, or SD compared to those with PD or mortality, with mean values of 64.2% and 36.9%, respectively. Patients who received concomitant TMZ and external beam radiotherapy showed a significant tumor size reduction of 178,837 mm³ (P < .001) compared to those treated with TMZ alone.

Conclusions: TMZ demonstrates promising efficacy in eliciting tumor responses in patients with PRA. O6-methylguanine DNA methyltransferase and MutS homologs 6 have emerged as potential biomarkers for predicting treatment response. Furthermore, radiation with concurrent TMZ may significantly improve outcomes in patients with RPA.

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治疗难治性垂体腺瘤的替莫唑胺疗法：39例患者的病例系列。

目的：难治性垂体腺瘤（RPA）的治疗面临巨大挑战。本研究旨在评估使用替莫唑胺（TMZ）治疗的RPA患者的长期治疗效果，并确定预测TMZ治疗反应的潜在生物标志物：该回顾性病例系列包括2014年1月至2021年12月期间在中国某综合医疗中心接受经蝶窦手术（TSS）或开颅手术的RPA患者：39名RPA患者（中位年龄42岁；23名男性（59%））接受了中位9个周期的TMZ治疗。中位随访时间为 34.4 个月。2例患者观察到完全反应（CR），11例患者观察到部分反应（PR），9例患者观察到疾病稳定（SD），11例患者观察到疾病进展（PD），6例患者死亡。与进展期或死亡患者相比，CR、PR 或 SD 患者的 MGMT（O6-甲基鸟嘌呤 DNA 甲基转移酶）水平明显较低，平均值分别为 24.2% 和 58.1。CR、PR或SD患者的MSH6（MutS homologs 6）水平明显高于PD或死亡患者，平均值分别为64.2%和36.9%。同时接受TMZ和体外放射治疗的患者肿瘤体积明显缩小了178,837立方毫米（p结论：TMZ对PRA患者的肿瘤反应具有良好的疗效。MGMT和MSH6已成为预测治疗反应的潜在生物标志物。此外，放疗同时配合 TMZ 可显著改善 RPA 患者的预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Endocrine Practice ENDOCRINOLOGY & METABOLISM-

CiteScore

7.60

自引率

2.40%

发文量

546

审稿时长

41 days

期刊介绍： Endocrine Practice (ISSN: 1530-891X), a peer-reviewed journal published twelve times a year, is the official journal of the American Association of Clinical Endocrinologists (AACE). The primary mission of Endocrine Practice is to enhance the health care of patients with endocrine diseases through continuing education of practicing endocrinologists.