title: The Role of Mifepristone in Meningiomas Management: A Systematic Review of the Literature.
abstract: OBJECTIVE
  We performed a systematic literature review to analyze the clinical application and the safety of mifepristone, a prominent antiprogesterone agent, in meningioma patients.
  
  
  METHODS
  A systematic search was performed through Medline, Cochrane, and clinicaltrials.gov databases from 1960 to 2014. Study Selection. Studies were selected through a PICO approach. Population was meningioma patients, meningioma cells cultures, and animal models. Intervention was mifepristone administration. Control was placebo administration or any other drug tested. Outcomes were clinical and radiological responsiveness, safety profile, and cell growth inhibition.
  
  
  RESULTS
  A total of 7 preclinical and 6 clinical studies and one abstract were included. Encouraging results were found in preclinical studies. Concerning clinical studies, the response rate to mifepristone in terms of radiological regression and symptomatic improvement/stability in patients with inoperable meningioma was low. In meningiomatosis, favorable preliminary results were recorded. The safety profile was good. Limitations were as follows. The tumoral expression of progesterone receptors was not analyzed systematically in every study considered.
  
  
  CONCLUSIONS
  No clear evidence exists to recommend mifepristone in inoperable meningiomas. Preliminary encouraging results were found in diffuse meningiomatosis. Mifepristone is a well-tolerated treatment. Patients' selection and hormonal profile analysis in meningiomas are fundamental for a better understanding of its benefit. Multicenter placebo-controlled trials are required.
authors.affiliation: Service of Neurosurgery, Department of Clinical Neuroscience, Faculty of Human Medicine and Biology, University Hospital of Lausanne, 46 rue du Bugnon, 1011 Lausanne, Switzerland.
authors.forename: Giulia
authors.initials: G
authors.lastname: Cossu
authors.affiliation: Service of Neurosurgery, Department of Clinical Neuroscience, Faculty of Human Medicine and Biology, University Hospital of Lausanne, 46 rue du Bugnon, 1011 Lausanne, Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Levivier
authors.affiliation: Service of Neurosurgery, Department of Clinical Neuroscience, Faculty of Human Medicine and Biology, University Hospital of Lausanne, 46 rue du Bugnon, 1011 Lausanne, Switzerland.
authors.forename: Roy Thomas
authors.initials: RT
authors.lastname: Daniel
authors.affiliation: Service of Neurosurgery, Department of Clinical Neuroscience, Faculty of Human Medicine and Biology, University Hospital of Lausanne, 46 rue du Bugnon, 1011 Lausanne, Switzerland ; Department of Neurosurgery, University Hospital of Bicetre, Faculty of Medicine of Paris Sud, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Messerer
mesh_terms: D000818:Animals; D019468:Disease Management; D006801:Humans; D008579:Meningioma / Q000188:drug therapy* / Q000473:pathology; D015735:Mifepristone / Q000008:administration & dosage* / Q000009:adverse effects; D011374:Progesterone / Q000378:metabolism*; D011980:Receptors, Progesterone / Q000378:metabolism*
chemical_list: D011980:Receptors, Progesterone; D015735:Mifepristone; D011374:Progesterone