title: Successful treatment of pituitary carcinoma with concurrent radiation, temozolomide, and bevacizumab after resection.
abstract: The optimal treatment of pituitary carcinomas (PC) is unknown. Treatment includes surgical resection, radiation, and more recently, temozolomide (TMZ). Pituitary adenomas have relatively high expression of vascular endothelial growth factor; therefore, bevacizumab, an antiangiogenic agent, has been used in a small number of aggressive or malignant pituitary tumors after recurrence. However, it has not been administered concurrently with other chemotherapeutic agents or combined with radiation therapy in PC. We present a 63-year-old man with an adrenocorticotropic hormone (ACTH)-secreting PC, causing visual loss. It was resected transsphenoidally. There were several notable factors placing the patient at high risk for recurrence including distant metastasis in the form of a pulmonary nodule. Morphologically, his tumor was a pituitary neoplasm with malignant histopathologic features. It had abundant mitotic figures and zones of necrosis. Six weeks post-surgery, the patient started concurrent chemoradiation, using combination therapy with TMZ and bevacizumab. TMZ was continued for 12 cycles in the adjuvant setting. The ACTH was effective as a serum-based tumor marker and normalized during treatment. The patient is alive, five years after diagnosis, with no recurrence to date. This is the first case of pituitary carcinoma treated successfully with concurrent chemoradiation therapy that combined TMZ and bevacizumab with a long-term follow up.
authors.affiliation: Department of Medicine, Division of Hematology, Oncology and Transplantation, University of Minnesota, 420 Delaware St. SE, MMC 480, Minneapolis, MN 55455, USA.
authors.forename: Waseem
authors.initials: W
authors.lastname: Touma
authors.affiliation: Department of Medicine, Division of Hematology, Oncology and Transplantation, University of Minnesota, 420 Delaware St. SE, MMC 480, Minneapolis, MN 55455, USA.
authors.forename: Spencer
authors.initials: S
authors.lastname: Hoostal
authors.affiliation: Regions Cancer Care Center, Department of Medicine, Regions Hospital, 640 Jackson Street, St. Paul, MN 55105, USA.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Peterson
authors.affiliation: Department of Medicine, Division of Hematology and Oncology, Hennepin County Medical Center, 701 Park Ave, Minneapolis, MN 55415, USA.
authors.forename: Andres
authors.initials: A
authors.lastname: Wiernik
authors.affiliation: Department of Pathology, University of New Mexico School of Medicine, 1 University of New Mexico Bldg, Albuquerque, NM 87131, USA.
authors.forename: Karen S
authors.initials: KS
authors.lastname: SantaCruz
authors.affiliation: Department of Medicine, Division of Hematology, Oncology and Transplantation, University of Minnesota, 420 Delaware St. SE, MMC 480, Minneapolis, MN 55455, USA. Electronic address: emil-lou@umn.edu.
authors.forename: Emil
authors.initials: E
authors.lastname: Lou
mesh_terms: D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols; D000068258:Bevacizumab / Q000008:administration & dosage / Q000627:therapeutic use*; D002277:Carcinoma / Q000601:surgery / Q000628:therapy*; D059248:Chemoradiotherapy; D003606:Dacarbazine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000601:surgery / Q000628:therapy*; D000077204:Temozolomide
chemical_list: D018906:Antineoplastic Agents, Alkylating; D000068258:Bevacizumab; D003606:Dacarbazine; D000077204:Temozolomide
keywords: Atypical pituitary adenoma; Bevacizumab; Pituitary carcinoma; Temozolomide