ECE2017 Eposter Presentations: Pituitary and Neuroendocrinology Clinical case reports - Pituitary/Adrenal (41 abstracts)
Introduction: Atypical pituitary adenomas are tumors refractory to conventional therapy and characterized by a tendency to rapid progression and high recurrence rate. The aim of the study was to summarize our experience in treatment of atypical pituitary adenomas with temozolomide (TMZ).
Material: 5 patients (3F;2M) aged 4458 (mean 52.4±5.4) years treated in 20132016. We analyzed the results, tolerance and side effects of TMZ.
Results: In three patients (1F;2M) atypical corticotroph adenomas were diagnosed (two Nelsons syndromes, one Crookes cells adenoma), in 1F-prolactinoma resistant to dopamine agonists and in 1F-type 3 silent adenoma (GH+, PRL+). The disease duration ranged 323 years (mean 12.4±7.2). Before TMZ implementation, patients underwent a total of 11 transsphenoidal adenomectomies (14), four craniotomies, two patients stereotactic X-ray-therapy, 1 tomotherapy and 2 bilateral adrenalectomy. All patients started with TMZ monotherapy 150 mg/m2 for five consecutive days with 23-days intervals. The number of courses ranged from 2 to 13. The total remission, lasting from 45 months was obtained in a patient with Crookes adenoma, partial remission in one patient with Nelsons syndrome, transient stable disease (24 months) in two patients (with Nelsons syndrome and somatotropinoma). The prolactinoma was refractory to TMZ. The only side effect was vomiting. In two patients with relapse of Nelsons syndrome TMZ was used in combination with bevacizumab (six courses) in 1F and in 1M with capecitabine (CAPTEM five courses), but in both cases it caused short-term disease stabilization.
Conclusion: TMZ is the most effective in treatment of atypical corticotroph adenomas as a single agent and in the first line of treatment, however it is less effective in recurrent form of the disease.
20 May 2017 - 23 May 2017