Document Detail


Temozolomide in the management of dopamine agonist-resistant prolactinomas.
MedLine Citation:
PMID:  22372583     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The majority of prolactinomas respond to dopamine agonist therapy, but a proportion are resistant, requiring other treatments including surgery and/or radiotherapy. Temozolomide is an oral chemotherapy agent, which has been used as a salvage therapy to treat aggressive pituitary adenomas and carcinomas, including prolactinomas, unresponsive to all conventional treatment.
CASE SERIES: We report three patients where temozolomide was used in the treatment of refractory prolactinomas. Case 1 describes a patient with a highly invasive prolactinoma, resistant to all conventional therapy, which responded dramatically to temozolomide used as a salvage treatment. In case 2, temozolomide was used after incomplete surgical resection to relieve chiasmal compression and avoid chiasm exposure to radiotherapy. In case 3, temozolomide enabled radiotherapy to be deferred in a 16-year old with a resistant prolactinoma. In all three cases, the tumours were negative by immunostaining for methylguanine methyltransferase (MGMT).
LITERATURE REVIEW AND DISCUSSION: A review of the published literature reveals 51 reported cases of temozolomide treatment for pituitary tumours, including 20 prolactinomas. Fifteen of the 20 prolactinomas showed a good response to temozolomide. Our analysis demonstrates a strong association between MGMT-negative staining and a good response to temozolomide (OR 9.35, P = 0.0030). Current clinical practice is to use temozolomide as a salvage therapy after all conventional modalities of treatment have failed. We suggest that, in selected cases, consideration should be given to using temozolomide earlier in the treatment algorithm.
Authors:
B C Whitelaw; D Dworakowska; N W Thomas; S Barazi; P Riordan-Eva; A P King; T Hampton; D B Landau; D Lipscomb; C R Buchanan; J A Gilbert; S J B Aylwin
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Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  Clinical endocrinology     Volume:  76     ISSN:  1365-2265     ISO Abbreviation:  Clin. Endocrinol. (Oxf)     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-04-23     Completed Date:  2012-08-17     Revised Date:  2013-07-15    
Medline Journal Info:
Nlm Unique ID:  0346653     Medline TA:  Clin Endocrinol (Oxf)     Country:  England    
Other Details:
Languages:  eng     Pagination:  877-86     Citation Subset:  IM    
Copyright Information:
© 2012 Blackwell Publishing Ltd.
Affiliation:
Department of Endocrinology, King's College Hospital, London, SE5 9RS, UK. benjamin.whitelaw@nhs.net
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Dacarbazine / analogs & derivatives*,  therapeutic use
Dopamine Agonists / therapeutic use*
Drug Resistance, Neoplasm / drug effects*
Humans
Male
Prolactinoma / drug therapy*
Chemical
Reg. No./Substance:
0/Dopamine Agonists; 4342-03-4/Dacarbazine; 85622-93-1/temozolomide

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