title: Temozolomide therapy in patients with aggressive pituitary adenomas or carcinomas.
abstract: Temozolomide is effective in some patients with progressive pituitary adenoma or carcinoma. We report a survey study of Italian patients treated with Temozolomide because of aggressive pituitary adenoma or carcinoma resistant to standard therapies. Italian endocrinologists were surveyed and asked to participate into the study. A questionnaire was sent to all those who agreed and had used Temozolomide in at least one patient with pituitary tumor. Database was closed in December 2013. A literature review was also performed. Thirty-one patients were included into the analysis. Mean age at start of Temozolomide treatment was 58.3 ± 1.9 years (± standard error). Six of the 31 (19.4%) Italian patients had a pituitary carcinoma. Twenty-five patients (80.6%) had disease control during Temozolomide treatment, while 6 patients (19.4%) had disease progression. Median follow-up after beginning Temozolomide was 43 months. Thirteen patients had tumor growth after stopping Temozolomide. The 2-year progression-free survival was 47.7% (95% CI 29.5-65.9%), while the 2-year disease control duration was 59.1% (95% CI 39.1-79.1%). Eleven patients died of progressive disease and other two patients of unrelated causes. The 2-year and 4-year overall survival rates were 83.9% (95% CI 70.7-97.1%) and 59.6% (95% CI 40.0-79.2%), respectively. Temozolomide is an additional effective therapeutic option for the treatment of aggressive pituitary tumors. The drug is well tolerated and causes few severe adverse effects. Recurrence of the tumor can occur after an initial positive response and usually portends a grim outcome.
authors.affiliation: Department of Neurosurgery, Istituto Scientifico San Raffaele, Università Vita-Salute, Via Olgettina 60, 20132, Milan, Italy. losa.marco@hsr.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Losa
authors.affiliation: Section of Endocrinology, Department of Clinical and Experimental Medicine, Ospedale Cisanello, University of Pisa, Pisa, Italy.
authors.forename: Fausto
authors.initials: F
authors.lastname: Bogazzi
authors.affiliation: Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
authors.forename: Salvo
authors.initials: S
authors.lastname: Cannavo
authors.affiliation: Endocrinology Unit, Department of Medicine, DIMED University-Hospital, Padua, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Ceccato
authors.affiliation: Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Curtò
authors.affiliation: Endocrinologia, Università Cattolica del Sacro Cuore, Policlinico A. Gemelli, Rome, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: De Marinis
authors.affiliation: Endocrinologia, Università Cattolica del Sacro Cuore, Policlinico A. Gemelli, Rome, Italy.|Endocrinology, Barts and The London School of Medicine, Queen Mary University of London, London, UK.
authors.forename: Donato
authors.initials: D
authors.lastname: Iacovazzo
authors.affiliation: Oncology Unit, Venetian Oncology Institute, Padua, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lombardi
authors.affiliation: Endocrinology and Diabetology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Mantovani
authors.affiliation: Department of Oncology, Istituto Scientifico San Raffaele, Università Vita-Salute, Milan, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Mazza
authors.affiliation: Department of Radiation Oncology, Sant'Andrea Hospital, "La Sapienza" University, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Minniti
authors.affiliation: Department of Endocrinology and Metabolic Disease, G.B. Morgagni Hospital, Forlì, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Nizzoli
authors.affiliation: Department of Oncology, Istituto Scientifico San Raffaele, Università Vita-Salute, Milan, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Reni
authors.affiliation: Endocrinology Unit, Department of Medicine, DIMED University-Hospital, Padua, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Scaroni
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000473:pathology; D000236:Adenoma / Q000188:drug therapy* / Q000473:pathology; D000328:Adult; D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use*; D003606:Dacarbazine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000473:pathology; D009367:Neoplasm Staging; D010911:Pituitary Neoplasms / Q000188:drug therapy* / Q000473:pathology; D011379:Prognosis; D015996:Survival Rate; D000077204:Temozolomide
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide
keywords: Chemotherapy; Pituitary carcinoma; Pituitary neoplasm; Pituitary surgery; Temozolomide