Recurrent meningioma: salvage therapy with long-acting somatostatin analogue.
BACKGROUND
Somatostatin receptors, especially the sst2A subtype, are present on most meningiomas. The addition of somatostatin inhibits meningioma growth in vitro in some studies. There have been anecdotal reports of octreotide inhibiting growth in meningiomas.


OBJECTIVE
A prospective pilot trial of sustained-release somatostatin (Sandostatin LAR) in 16 patients with recurrent meningiomas was conducted with a primary study objective of progression-free survival at 6 months.


METHODS
Sixteen patients (11 women, 5 men; median age 58) with recurrent meningioma were treated prospectively with long-acting somatostatin. Patients had progressed radiographically after prior therapy with surgery (14/16; complete resection in 5; subtotal in 7; biopsy only in 2), radiotherapy (13/16), and chemotherapy (12/16). All patients had confirmation of the presence of somatostatin receptors in their tumor using (111)In-octreotide, a long-acting somatostatin agonist, SPECT scanning.


RESULTS
Patients received 2 to 15 cycles (median 4.5) of somatostatin with minimal toxicity. Five [corrected] partial responses, five stable disease, and six [corrected] progressive disease patterns were seen. Duration of response ranged from 2 to 20+ months (median 5.0 months). Median survival was 7.5 months (range 3 to 20+). The overall progression-free survival was 44% (seven patients) at 6 months.


CONCLUSIONS
In this small trial of patients with recurrent meningiomas shown to overexpress somatostatin receptors by octreotide scintigraphy, long-acting somatostatin (Sandostatin LAR) was administered on a monthly schedule. Thirty-one percent of patients demonstrated a partial radiographic response and 44% achieved progression-free survival at 6 months. Toxicity was minimal, suggesting somatostatin analogues may offer a novel, relatively nontoxic alternative treatment for recurrent meningiomas.
Chamberlain
Marc C
MC
Department of Interdisciplinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA. chambemc@u.washington.edu
Glantz
Michael J
MJ
Fadul
Camilo E
CE
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003692:Delayed-Action Preparations; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000517:prevention & control; D008579:Meningioma / Q000188:drug therapy* / Q000473:pathology / Q000517:prevention & control; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000473:pathology / Q000517:prevention & control; D010865:Pilot Projects; D011446:Prospective Studies; D016879:Salvage Therapy / Q000379:methods*; D013004:Somatostatin / Q000008:administration & dosage* / Q000031:analogs & derivatives* / Q000737:chemistry