Course of Aggressive Somatotroph, Corticotroph and Mammotroph Tumors under Temozolomide: Report of Three Cases and Review of the Literature

Özet

Treatment of aggressive pituitary tumors may be challenging. Temozolomide (TMZ) is a promising agent when conventional treatmentmethods fail. We present three patients with aggressive pituitary tumors with atypical morphology, who were resistant to conventionaltreatments and treated with TMZ. The first case had a somatotroph adenoma, the second a corticotroph adenoma, and the third amacroprolactinoma. We also reviewed the literature reporting TMZ efficacy in somatotroph, corticotroph and mammotroph tumorsof the pituitary gland. TMZ with a schedule of 150–200 mg/m2 for 5 days every 28 days was administered to all patients. Eventhough only the case of macroprolactinoma had a favorable response to TMZ treatment among our patients, both radiologicaland hormonal recurrence occurred 30 months after the cessation of TMZ treatment. TMZ treatment was then administered again.Cases of somatotroph and corticotroph adenomas had progressed under TMZ treatment and the patients were lost due to masseffect of the tumor. A review of the literature demonstrated 67.3%, 60% and 26.7% overall response rates to TMZ treatment inprolactinoma, corticotropinoma and somatostatinoma cases, respectively. There is still a need to define response criteria uniformlyto TMZ treatment in aggressive pituitary tumors. The duration of response should be reported for reliable evaluation of results.