Temozolomide Treatment Can Improve Overall Survival in Aggressive Pituitary Tumors and Pituitary Carcinomas
Presentation Number: OR22-3
Date of Presentation: April 1st, 2017
Helene Lasolle1, Christine Cortet2, Frederic Castinetti3, Lucie Cloix4, Philippe Caron5, Rachel Desailloud6, Brigitte Delemer7, Cristel Jublanc8, Jean-Louis Sadoul9, Nathalie Bourcigaux10, Olivier Chabre11, Philippe Chanson12, Cyril Garcia13, Magalie Haissaguerre14, Yves Reznik15, Franck Schillo16, Guillaume Assie17 and Gérald Raverot*18
1hospices Cicils de Lyon, lyon, France, 2Lille University Hospital, Lille cedex, France, 3La Conception Hospital, Marseille, France, 4Hôpital Bretonneau, CHRU de Tours, Tours, France, 5CHU Larrey, Toulouse, France, 6CHRU Amien, Amiens, France, 7CHU Reims, Reims, France, 8AP-HP, 9CHU Nice, Nice Cedex, France, 10AP-HP, Paris, 11Grenoble University Hospital, Grenoble, France, 12Assistance publique Hôpitaux de Paris- Hôpital Bicêtre-Université Paris-Sud Paris, France, 13Hopital Instruction des Armées, Saint Mande, FRANCE, 14University Bordeaux 2/Hopital Haut Leveque, Pessac, France, 15Caen University Hospital, Caen, France, 16CHU Besancon, Besancon, France, 17Assistance Publique Hôpitaux de Paris, Paris, France, 18Hospices Civils de Lyon, Lyon Cedex 03, France
Objectives: Some case-reports and limited retrospective studies have reported the successful use of temozolomide (TMZ) in pituitary tumors (PT), with an efficacy rate of around 50% depending on studied criteria. However, the long term survival of patients treated with TMZ has rarely been evaluated. We therefore aimed to describe the use of TMZ on PT in clinical practice and evaluate the long-term survival.
Design: Multicenter retrospective study by members of the French Society of Endocrinology.
Methods: Forty-three patients (14 women) treated with TMZ between 2006 and 2016 were included. Most tumors were corticotroph (n=23) or lactotroph (n=13), and 14 were carcinomas. Clinical/pathological characteristics of PT as well as data from treatment evaluation and at the last follow-up were recorded. A partial response was considered if the maximal tumor diameter had decreased by more than 30% and/or the hormonal rate by more than 50% at the end of treatment.
Results: The median treatment duration was 6.5 cycles (range 2-24), using a standard regimen for most and combined radiotherapy for six. Twenty-three patients (53.5%) were considered as responders. Silent tumor at diagnosis, though not MGMT expression, was associated with a poor response at multivariate analysis. The median follow-up after the end of treatment was 16 months [0-72] at which time 18 patients had deceased, 13 of whom were non-responders. Overall survival was significantly higher among responders (p=0.002) however ten patients relapsed 5 months (ranges 0-57) after the end of TMZ treatment, five in whom TMZ was reinitiated but without success.
Discussion: Patients in our series showed a 53.5% response rate to TMZ, with an improved survival among responders despite frequent relapses. Our study highlights the high variability and lack of standardization of treatment protocols.
Nothing to Disclose: HL, CC, FC, LC, PC, RD, BD, CJ, JLS, NB, OC, PC, CG, MH, YR, FS, GA, GR