Temozolomide-induced shrinkage of a pituitary carcinoma causing Cushing's disease--report of a case and literature review.
Temozolomide (TMZ) is an alkylating chemotherapeutic agent that has recently been used in some cases as a new therapeutic tool for pituitary carcinomas and aggressive pituitary adenomas. In this report, we present the case of effective TMZ treatment in a 42-year-old man with ACTH-secreting carcinoma. The tumor grew progressively over 4 years, from 2.2 to 31.1 cm³, despite three surgical approaches and γ-knife treatment. Ki-67 increased from 2 to 18%. An intradural metastasis at the foramen magnum was detected by MRI after the third operation. Thereafter, four cycles of 5-day TMZ administration (200 mg/m²/day during the first, and 150 mg/m²/day during the following cycles) induced dramatic tumor size reduction (>90%). Clinical conditions improved progressively and, after 17 months from the beginning of TMZ administration, the patient is still alive. The treatment was well tolerated except for a transient thrombocytopenia (grade 4 WHO).
Department of Medicine and Pharmacology, Section of Endocrinology, Erasmus Medical Center, Rotterdam, The Netherlands. curto.loren@libero.it
Lorenzo
L
Curtò
Maria L
ML
Torre
Francesco
F
Ferraù
Vincenzo
V
Pitini
Giuseppe
G
Altavilla
Francesca
F
Granata
Marcello
M
Longo
Leo J
LJ
Hofland
Francesco
F
Trimarchi
Salvatore
S
Cannavò
D000236:Adenoma / Q000188:drug therapy* / Q000378:metabolism; D000324:Adrenocorticotropic Hormone / Q000378:metabolism; D000328:Adult; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D003606:Dacarbazine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D047748:Pituitary ACTH Hypersecretion / Q000188:drug therapy* / Q000378:metabolism; D010911:Pituitary Neoplasms / Q000188:drug therapy* / Q000378:metabolism; D000077204:Temozolomide; D016896:Treatment Outcome
D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000324:Adrenocorticotropic Hormone; D000077204:Temozolomide