Temozolomide (Temodar®) and capecitabine (Xeloda®) treatment of an aggressive corticotroph pituitary tumor.
Temozolomide (Temodar®) and capecitabine (Xeloda®) treatment of an aggressive corticotroph pituitary tumor.
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替莫唑胺 (Temodar®) 和卡培他滨 (Xeloda®) 治疗侵袭性促肾上腺皮质激素垂体瘤。
DOI：
10.1007/s11102-009-0211-1
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发表时间：
2011
期刊：
影响因子：
3.8
通讯作者：
Fine,RobertL
中科院分区：
文献类型：
--
作者：
Thearle,MarieS;Freda,PamelaU;Bruce,JeffreyN;Isaacson,StevenR;Lee,Yoomi;Fine,RobertL
促肾上腺皮质激素垂体瘤只有很少的侵袭性，导致颅神经和其他局部结构受压引起的症状。当侵袭性垂体神经内分泌肿瘤确实发展时，常规治疗选择的成功有限。一名50岁男性在初次就诊后2年发生巨大侵袭性促肾上腺皮质激素垂体瘤。他的肿瘤和症状未能响应最大的手术，放射外科，放射和药物治疗和双侧肾上腺切除术。随后，他的肿瘤迅速生长，导致多个颅神经缺损。他接受了卡培他滨和替莫唑胺（CAPTEM）的挽救化疗，这是我们机构开发的一种新型口服化疗方案，用于治疗神经内分泌肿瘤。经过两个周期的CAPTEM治疗后，他的肿瘤明显缩小，ACTH水平下降了近90%。尽管ACTH水平进一步降低，但5个月后肿瘤复发，PET扫描显示亲和力增加，表明向更具侵袭性的表型转化。已报告替莫唑胺对其他垂体肿瘤有效，该病例补充了该文献，证明其与卡培他滨（CAPTEM）一起沿着用于促肾上腺皮质激素细胞肿瘤。对经典治疗无效的垂体神经内分泌肿瘤患者进一步评价CAPTEM方案是必要的。
Only rarely do corticotroph pituitary tumors become invasive leading to symptoms caused by compression of cranial nerves and other local structures. When aggressive pituitary neuroendocrine tumors do develop, conventional treatment options are of limited success. A 50-year-old man developed a giant invasive corticotroph pituitary tumor 2 years after initial presentation. His tumor and symptoms failed to respond to maximal surgical, radio-surgical, radiation and medical therapy and a bilateral adrenalectomy was done. He subsequently developed rapid growth of his tumor leading to multiple cranial nerve deficits. He was administered salvage chemotherapy with capecitabine and temozolomide (CAPTEM), a novel oral chemotherapy regimen developed at our institution for treatment of neuroendocrine tumors. After two cycles of CAPTEM, his tumor markedly decreased in size and ACTH levels fell by almost 90%. Despite further decreases in ACTH levels, his tumor recurred after 5 months with increased avidity on PET scan suggesting a transformation to a more aggressive phenotype. Temozolomide had been reported to be effective against other pituitary tumors and this case adds to this literature demonstrating its use along with capecitabine (CAPTEM) against a corticotroph tumor. Further evaluation of the CAPTEM regimen in patients with pituitary neuroendocrine tumors which fail to respond to classic treatments is warranted.