title: Low O6-methylguanine-DNA methyltransferase (MGMT) expression and response to temozolomide in aggressive pituitary tumours.
abstract: BACKGROUND
  Recent case reports detail the successful use of temozolomide in the management of aggressive pituitary tumours. O(6)-methylguanine-DNA methyltransferase (MGMT) is a DNA repair protein that counteracts the effect of temozolomide.
  
  
  OBJECTIVE
  To study MGMT expression in pituitary tumours and consider whether MGMT expression is associated with response to temozolomide therapy in aggressive pituitary tumours.
  
  
  METHODS
  We report two patients with aggressive pituitary tumours treated with temozolomide, one who responded to temozolomide and the other who did not. MGMT expression was assessed in a further 88 archived pituitary tumour samples.
  
  
  METHODS
  MGMT expression was assessed by immunohistochemistry. MGMT promoter methylation was studied by methylation-specific polymerase chain reaction (MSP), sequencing of MGMT was performed and loss of heterozygosity (LOH) analysis undertaken.
  
  
  RESULTS
  Low MGMT expression and MGMT promoter methylation were found in the pituitary tumour of the patient who responded to temozolomide. Conversely, high MGMT expression was seen in the patient demonstrating a poor response to temozolomide. Eleven out of 88 archived tumour samples (13%) had low MGMT expression. Prolactinomas were more likely to have low MGMT expression compared with other pituitary tumour subtypes (P < 0.001). There was no significant difference in MGMT expression between invasive and noninvasive tumours, or between recurrent and nonrecurrent tumours. A significant inverse correlation was found between MGMT expression and promoter methylation (P = 0.012).
  
  
  CONCLUSIONS
  MGMT expression as assessed by immunohistochemistry may predict response to temozolomide therapy in patients with aggressive pituitary tumours. MGMT promoter methylation is likely to explain low MGMT expression in some, but not all, pituitary tumours.
authors.affiliation: Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia. amccorma@med.usyd.edu.au
authors.forename: Ann I
authors.initials: AI
authors.lastname: McCormack
authors.forename: Kerrie L
authors.initials: KL
authors.lastname: McDonald
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Gill
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Clark
authors.forename: Morton G
authors.initials: MG
authors.lastname: Burt
authors.forename: Kirsten A
authors.initials: KA
authors.lastname: Campbell
authors.forename: Wilton J
authors.initials: WJ
authors.lastname: Braund
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Little
authors.forename: Raymond J
authors.initials: RJ
authors.lastname: Cook
authors.forename: Ashley B
authors.initials: AB
authors.lastname: Grossman
authors.forename: Bruce G
authors.initials: BG
authors.lastname: Robinson
authors.forename: Roderick J
authors.initials: RJ
authors.lastname: Clifton-Bligh
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003606:Dacarbazine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D015870:Gene Expression / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019853:O(6)-Methylguanine-DNA Methyltransferase / Q000235:genetics* / Q000378:metabolism; D010911:Pituitary Neoplasms / Q000188:drug therapy* / Q000201:enzymology / Q000235:genetics / Q000473:pathology; D000077204:Temozolomide
chemical_list: D003606:Dacarbazine; D019853:O(6)-Methylguanine-DNA Methyltransferase; D000077204:Temozolomide