Abstract
Pituitary carcinoma is a rare malignancy and is difficult to manage. Pituitary carcinomas commonly produce either PRL or ACTH, but some do not produce pituitary hormones. The alkylating reagent temozolomide (TMZ) was recently shown to be effective as a treatment for pituitary carcinoma. Most of the published reports of TMZ use in pituitary carcinoma cases were against hormone-producing carcinomas. Only a few patients with a nonfunctioning pituitary carcinoma treated with TMZ have been reported. Here we describe our treatment of a patient with nonfunctioning pituitary carcinoma and a background of multiple endocrine neoplasia type 1. The pituitary carcinoma was accompanied by meningeal dissemination with cerebral and L1 spinal bone metastasis. The patient received continuous dosing of TMZ along with external radiation, followed by standard dosing of TMZ. There was an apparent antitumor response seen in MRI. MGMT, an enzyme antagonized by TMZ, was negative in the tumor. The therapeutic efficacy of TMZ and dosing schedules of TMZ in pituitary carcinoma are discussed.
Highlights
Pituitary carcinomas are quite rare; they comprise only about 0.1% of pituitary tumors
This concept is supported by higher p53 expression and MIB-1 indices in the recurrent tumor tissues compared to the primary tumor tissues [4,5,6]
The successful use of TMZ has been reproduced in several patients with pituitary carcinoma or refractory atypical pituitary adenoma [12,13,14]
Summary
A Case of Nonfunctioning Pituitary Carcinoma That Responded to Temozolomide Treatment. Pituitary carcinoma is a rare malignancy and is difficult to manage. Pituitary carcinomas commonly produce either PRL or ACTH, but some do not produce pituitary hormones. The alkylating reagent temozolomide (TMZ) was recently shown to be effective as a treatment for pituitary carcinoma. Most of the published reports of TMZ use in pituitary carcinoma cases were against hormoneproducing carcinomas. A few patients with a nonfunctioning pituitary carcinoma treated with TMZ have been reported. We describe our treatment of a patient with nonfunctioning pituitary carcinoma and a background of multiple endocrine neoplasia type 1. The pituitary carcinoma was accompanied by meningeal dissemination with cerebral and L1 spinal bone metastasis. The therapeutic efficacy of TMZ and dosing schedules of TMZ in pituitary carcinoma are discussed
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