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JCEM替莫唑胺治疗侵袭性垂体瘤
JCEM:替莫唑胺治疗侵袭性垂体瘤
医脉通
文献标题：Temozolomidetreatmentinaggressivepituitarytumorsandpituitarycarcinomas:aFrenchmulticenterexperience.文献出处：JClinEndocrinolMetab.,95(10):-9.期刊影响因子：6.文献类型：EvaluationStudies,MulticenterStudy本文介绍了替莫唑胺治疗侵袭性垂体瘤/癌患者的抗肿瘤疗效和毒性。这是迄今为止有关该课题中已发表的最大的一项。垂体瘤约占所有颅内肿瘤的15％，35-40％的病例与局部侵润有关。垂体癌是一种罕见的疾病（约0.2％的垂体瘤）以出现脑脊髓和/或全身转移存灶来确诊。替莫唑胺是一种口服的二代DNA烷化剂，在中枢神经系统有着优良生物利用度。替莫唑胺用来治疗神经内分泌肿瘤和胶质母细胞瘤。8例患者包括5例垂体癌（催乳素[PRL]型3例和促肾上腺皮质激素[ACTH]型2例），3例侵袭性垂体瘤（催乳素[PRL]型1例和促肾上腺皮质激素[ACTH]型2例）。由于在这个多中心研究中存在转移灶或常规治疗（药物治疗，手术[每例患者都有1-4次重复手术]或放射治疗[1-3分次立体定向放射治疗]）、放疗后肿瘤控制不良，因此给予替莫唑胺治疗。对MGMT表达和MGMT启动子甲基化进行评估。1例催乳素型癌和2例促肾上腺皮质激素型瘤显示激素样和肿瘤样治疗反应但未证实与MGMT表达或MGMT启动子甲基化有关。1例患者因粒细胞缺乏症，2例因血小板减少而中止治疗，需要减小剂量。由于延迟肿瘤反应在患者中出现的可能性不大，3个疗程的替莫唑胺治疗足以确定治疗反应。这项研究证实，替莫唑胺治疗有益于常规治疗没有反应的侵袭性垂体瘤或癌。MGMT状态不能很好预测疗效。有必要进行更大型的前瞻性研究以确定替莫唑胺反应预测因素。医脉通推荐英文摘要JClinEndocrinolMetab.Oct;95(10):-9.
Temozolomidetreatmentinaggressivepituitarytumorsandpituitarycarcinomas:aFrenchmulticenterexperience.RaverotG,SturmN,deFraipontF,MullerM,SalenaveS,CaronP,ChabreO,ChansonP,etal.
CONTEXT:Todateonly18patientswithaggressivepituitarytumorsorcarcinomastreatedwithtemozolomidehavebeenreported.IncreasedexpressionofO6-methylguanine-DNA-methyltranferase(MGMT)hasbeensuggestedtopredictresistancetotemozolomide.OBJECTIVES:TheobjectiveofthestudywastodescribetheantitumoralefficacyandtoxicityoftemozolomideinpatientswithaggressivepituitarytumorsorcarcinomasandevaluatethepossibleprognosticvalueofMGMTpromotermethylationandproteinexpression.PATIENTS:Eightpatients,fivewithpituitarycarcinomas(threeprolactin(PRL)andtwoACTH)andthreewithaggressivepituitarytumors(onePRLandtwoACTH),alltreatedwithtemozolomideadministeredorallyforfourto24cycles,wereincludedinourFrenchmulticenterstudy.DESIGN:MGMTexpressionwasassessedbyimmunohistochemistryandMGMTpromotermethylationbypyrosequencing.RESULTS:Threeoftheeightpatients(twoACTHadenomasandonePRLcarcinoma)respondedtotemozolomideasdemonstratedbysignificanttumorshrinkageandreducedhormonesecretion.Threecyclesoftemozolomideweresufficienttoidentifytreatment-responsivepatients.Additionalcyclesdidnotimprovetreatmentefficacyinthosenotresponding,evenwhenassociatedwithcarboplatinandvepeside.MGMTexpressiondidnotpredicttumoralresponsetotemozolomidebecauseitwaspositiveinoneresponderandnegativeintwononresponders.Similarly,MGMTpromotermethylation(threeofseventumors)didnotpredictclinicalresponse.Toxicityremainedmildinallpatients.CONCLUSION:Temozolomidetreatmentmaybeaneffectiveoptionforsomeaggressivepituitarytumorsorcarcinomas.ResponsetoatrialofthreecyclesoftreatmentseemssufficienttoidentifyrespondersandmorereliablethanpatientMGMTstatus.
文献来源RaverotG,etal.Temozolomidetreatmentinaggressivepituitarytumorsandpituitarycarcinomas:aFrenchmulticenterexperience.JClinEndocrinolMetab.Oct;95(10):-9.[PubMed链接
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