REVIEW
Aggressive pituitary tumours: the role of temozolomide and the assessment of MGMT status
Ann I. McCormack,
John A. H. Wass,
Ashley B. Grossman,
Ann I. McCormack
Cancer Genetics Unit, Hormones and Cancer Group, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia
Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UK
Search for more papers by this authorJohn A. H. Wass
Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UK
Search for more papers by this authorAshley B. Grossman
Department of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine, London, UK
Search for more papers by this authorAnn I. McCormack,
John A. H. Wass,
Ashley B. Grossman,
Ann I. McCormack
Cancer Genetics Unit, Hormones and Cancer Group, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia
Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UK
Search for more papers by this authorJohn A. H. Wass
Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UK
Search for more papers by this authorAshley B. Grossman
Department of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine, London, UK
Search for more papers by this authorDr Ann McCormack, Cancer Genetics Unit, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW 2065, Australia. Tel.: +61 2 9926 7176; fax: +61 2 9926 8484; e-mail: [email protected]
Abstract
Eur J Clin Invest 2011; 41 (10): 1133–1148
Background Aggressive pituitary tumours are associated with substantial morbidity and mortality. Treatment options are often limited, and chemotherapy has been reserved as salvage therapy although historically results have often been disappointing. However, temozolomide, an oral alkylating agent, has recently demonstrated significant activity against these tumours. A DNA repair protein, 06-methylguanine-DNA methyltransferase (MGMT) has been suggested as a biomarker to predict response to temozolomide in pituitary tumours.
Materials and methods This paper will review the current literature on temozolomide and pituitary tumours and discuss the recent controversy surrounding the value of determining the MGMT status in this tumour group. A PubMed search was performed to retrieve articles, using the terms ‘pituitary tumour’ and ‘temozolomide’.
Results Overall, 24/40 (60%) of the published cases demonstrated a response to temozolomide therapy. The highest response rates were seen amongst prolactinomas (73%) and ACTH-secreting tumours (60%), whilst nonfunctioning pituitary tumours exhibit lower response rates (40%). Responsivity is typically evident in the first 3 months of therapy and may be dramatic and sustained. Low MGMT expression, as determined by immunohistochemistry, is associated with a high response rate (76%), whilst high MGMT expression has not been associated with responses. MGMT promoter methylation does not correlate with temozolomide response.
Conclusions Temozolomide is the first chemotherapeutic agent to show substantial response rates in aggressive pituitary tumours. MGMT immunohistochemistry, but not MGMT methylation analysis, shows promise as a predictive tool. Prospective clinical trials are now necessary to more accurately determine the efficacy of this agent in this patient group.
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