Apatinib (YN968D1) and Temozolomide in Recurrent Invasive Pituitary Adenoma: Case Report and Literature Review
Invasive pituitary adenomas often recurred after postoperative radiotherapy and are difficult to treat. Temozolomide is an alkylating cytostaticum and has been reported to reduce pituitary tumor size and hormone hypersecretion. However, this is far from enough. Pituitary adenomas have relatively hig...
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Published in | World neurosurgery Vol. 124; pp. 319 - 322 |
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01.04.2019
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Abstract | Invasive pituitary adenomas often recurred after postoperative radiotherapy and are difficult to treat. Temozolomide is an alkylating cytostaticum and has been reported to reduce pituitary tumor size and hormone hypersecretion. However, this is far from enough. Pituitary adenomas have relatively high expression of vascular endothelial growth factor. Therefore an antiangiogenic agent has been used in a small number of aggressive or malignant pituitary tumors after recurrence. Apatinib (YN968D1) is a small-molecule antiangiogenic agent that selectively inhibits VEGFR-2 and also mildly inhibits c-Kit and c-Src tyrosine kinases, abundant in invasive pituitary adenomas.
We present a 41-year-old female with a growth hormone (GH)-secreting invasive pituitary adenoma causing menstrual disorder and headache symptoms. Over 3 years, she underwent 4 surgeries and a stereotactic radiosurgery, but the results were poor. Two months after the fourth operation, she started treatment with temozolomide (200 mg/m2, days 1−5, 28 days, orally) and apatinib (0.425 g, daily, orally). Her GH level dropped to normal with a >90% decrease in tumor size, after 1-year treatment. There was no evidence of recurrence by imaging or by serum GH levels over 31.5 months of follow-up.
We successfully treated this patient with recurrent invasive pituitary adenoma with temozolomide and apatinib for 31.5 months without recurrence. Angiogenesis is an active process in the cases of invasive pituitary adenomas that cannot be controlled by conventional therapy. |
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AbstractList | Invasive pituitary adenomas often recurred after postoperative radiotherapy and are difficult to treat. Temozolomide is an alkylating cytostaticum and has been reported to reduce pituitary tumor size and hormone hypersecretion. However, this is far from enough. Pituitary adenomas have relatively high expression of vascular endothelial growth factor. Therefore an antiangiogenic agent has been used in a small number of aggressive or malignant pituitary tumors after recurrence. Apatinib (YN968D1) is a small-molecule antiangiogenic agent that selectively inhibits VEGFR-2 and also mildly inhibits c-Kit and c-Src tyrosine kinases, abundant in invasive pituitary adenomas.
We present a 41-year-old female with a growth hormone (GH)-secreting invasive pituitary adenoma causing menstrual disorder and headache symptoms. Over 3 years, she underwent 4 surgeries and a stereotactic radiosurgery, but the results were poor. Two months after the fourth operation, she started treatment with temozolomide (200 mg/m2, days 1−5, 28 days, orally) and apatinib (0.425 g, daily, orally). Her GH level dropped to normal with a >90% decrease in tumor size, after 1-year treatment. There was no evidence of recurrence by imaging or by serum GH levels over 31.5 months of follow-up.
We successfully treated this patient with recurrent invasive pituitary adenoma with temozolomide and apatinib for 31.5 months without recurrence. Angiogenesis is an active process in the cases of invasive pituitary adenomas that cannot be controlled by conventional therapy. BACKGROUNDInvasive pituitary adenomas often recurred after postoperative radiotherapy and are difficult to treat. Temozolomide is an alkylating cytostaticum and has been reported to reduce pituitary tumor size and hormone hypersecretion. However, this is far from enough. Pituitary adenomas have relatively high expression of vascular endothelial growth factor. Therefore an antiangiogenic agent has been used in a small number of aggressive or malignant pituitary tumors after recurrence. Apatinib (YN968D1) is a small-molecule antiangiogenic agent that selectively inhibits VEGFR-2 and also mildly inhibits c-Kit and c-Src tyrosine kinases, abundant in invasive pituitary adenomas. CASE DESCRIPTIONWe present a 41-year-old female with a growth hormone (GH)-secreting invasive pituitary adenoma causing menstrual disorder and headache symptoms. Over 3 years, she underwent 4 surgeries and a stereotactic radiosurgery, but the results were poor. Two months after the fourth operation, she started treatment with temozolomide (200 mg/m2, days 1-5, 28 days, orally) and apatinib (0.425 g, daily, orally). Her GH level dropped to normal with a >90% decrease in tumor size, after 1-year treatment. There was no evidence of recurrence by imaging or by serum GH levels over 31.5 months of follow-up. CONCLUSIONSWe successfully treated this patient with recurrent invasive pituitary adenoma with temozolomide and apatinib for 31.5 months without recurrence. Angiogenesis is an active process in the cases of invasive pituitary adenomas that cannot be controlled by conventional therapy. Invasive pituitary adenomas often recurred after postoperative radiotherapy and are difficult to treat. Temozolomide is an alkylating cytostaticum and has been reported to reduce pituitary tumor size and hormone hypersecretion. However, this is far from enough. Pituitary adenomas have relatively high expression of vascular endothelial growth factor. Therefore an antiangiogenic agent has been used in a small number of aggressive or malignant pituitary tumors after recurrence. Apatinib (YN968D1) is a small-molecule antiangiogenic agent that selectively inhibits VEGFR-2 and also mildly inhibits c-Kit and c-Src tyrosine kinases, abundant in invasive pituitary adenomas. We present a 41-year-old female with a growth hormone (GH)-secreting invasive pituitary adenoma causing menstrual disorder and headache symptoms. Over 3 years, she underwent 4 surgeries and a stereotactic radiosurgery, but the results were poor. Two months after the fourth operation, she started treatment with temozolomide (200 mg/m , days 1-5, 28 days, orally) and apatinib (0.425 g, daily, orally). Her GH level dropped to normal with a >90% decrease in tumor size, after 1-year treatment. There was no evidence of recurrence by imaging or by serum GH levels over 31.5 months of follow-up. We successfully treated this patient with recurrent invasive pituitary adenoma with temozolomide and apatinib for 31.5 months without recurrence. Angiogenesis is an active process in the cases of invasive pituitary adenomas that cannot be controlled by conventional therapy. |
Author | Tao, Rongjie He, Qiaowei Zhu, Yufang Xu, Jun Meng, Xiangji Wang, Yong Zhou, Shizhen |
Author_xml | – sequence: 1 givenname: Yong surname: Wang fullname: Wang, Yong organization: Department of Neurosurgery, Shandong Cancer Hospital Affiliated with Shandong University, Shandong Academy of Medical Sciences, Jinan, China – sequence: 2 givenname: Qiaowei surname: He fullname: He, Qiaowei organization: Department of Neurosurgery, Qingdao University Affiliated with Yantai Yuhuangding Hospital, Yantai, China – sequence: 3 givenname: Xiangji surname: Meng fullname: Meng, Xiangji organization: Department of Neurosurgery, Shandong Cancer Hospital Affiliated with Shandong University, Shandong Academy of Medical Sciences, Jinan, China – sequence: 4 givenname: Shizhen surname: Zhou fullname: Zhou, Shizhen organization: Department of Neurosurgery, Shandong Cancer Hospital Affiliated with Shandong University, Shandong Academy of Medical Sciences, Jinan, China – sequence: 5 givenname: Yufang surname: Zhu fullname: Zhu, Yufang organization: Department of Neurosurgery, Shandong Cancer Hospital Affiliated with Shandong University, Shandong Academy of Medical Sciences, Jinan, China – sequence: 6 givenname: Jun surname: Xu fullname: Xu, Jun organization: Department of Neurosurgery, Shandong Cancer Hospital Affiliated with Shandong University, Shandong Academy of Medical Sciences, Jinan, China – sequence: 7 givenname: Rongjie surname: Tao fullname: Tao, Rongjie email: rongjietao@163.com organization: Department of Neurosurgery, Shandong Cancer Hospital Affiliated with Shandong University, Shandong Academy of Medical Sciences, Jinan, China |
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Cites_doi | 10.1677/joe.1.06992 10.1124/pr.56.4.3 10.1016/j.jocn.2017.02.052 10.1530/EJE-16-0979 10.1124/jpet.110.177790 10.1016/j.wneu.2018.07.082 10.1186/1471-2407-14-820 10.1358/dot.2015.51.4.2320599 10.1007/s11102-011-0346-8 10.1200/JCO.2015.63.5995 10.2147/DDDT.S97235 10.1186/s12885-018-4303-z |
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Keywords | Apatinib TMZ GH Chemotherapy Invasive pituitary adenomas Antiangiogenic therapy MRI VEGF Temozolomide |
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pituitary carcinoma publication-title: Pituitary doi: 10.1007/s11102-011-0346-8 contributor: fullname: Ortiz – volume: 34 start-page: 1448 year: 2016 ident: 10.1016/j.wneu.2018.12.174_bib15 article-title: Randomized, double-blind, placebo-controlled phase iii trial ofapatinibin patients with chemotherapy-refractory advanced or metastatic adenocarcinoma of the stomach or gastroesophageal junction publication-title: J Clin Oncol doi: 10.1200/JCO.2015.63.5995 contributor: fullname: Li – volume: 9 start-page: 6075 year: 2015 ident: 10.1016/j.wneu.2018.12.174_bib4 article-title: Apatinib for molecular targeted therapy in tumor publication-title: Drug Des Devel Ther doi: 10.2147/DDDT.S97235 contributor: fullname: Zhang – volume: 18 start-page: 396 year: 2018 ident: 10.1016/j.wneu.2018.12.174_bib14 article-title: Apatinib for advanced sarcoma: results from multiple institutions’ off-label use in China publication-title: BMC Cancer doi: 10.1186/s12885-018-4303-z contributor: fullname: Xie |
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Snippet | Invasive pituitary adenomas often recurred after postoperative radiotherapy and are difficult to treat. Temozolomide is an alkylating cytostaticum and has been... BACKGROUNDInvasive pituitary adenomas often recurred after postoperative radiotherapy and are difficult to treat. Temozolomide is an alkylating cytostaticum... |
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SubjectTerms | Antiangiogenic therapy Apatinib Chemotherapy Invasive pituitary adenomas Temozolomide |
Title | Apatinib (YN968D1) and Temozolomide in Recurrent Invasive Pituitary Adenoma: Case Report and Literature Review |
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