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TheScientificWorldJOURNAL
Volume 10, Pages 2132-2138
http://dx.doi.org/10.1100/tsw.2010.210
Case Study

Temozolomide-Induced Shrinkage of a Pituitary Carcinoma Causing Cushing's Disease — Report of a Case and Literature Review

1Department of Medicine and Pharmacology, Section of Endocrinology, University of Messina, Italy
2Department of Medical Oncology, University of Messina, Italy
3Department of Radiological Sciences, University of Messina, Italy
4Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Center, Rotterdam, The Netherlands

Received 10 September 2010; Revised 19 October 2010; Accepted 20 October 2010

Academic Editor: Lawrence A. Frohman

Copyright © 2010 Lorenzo Curtò et al.

Abstract

Temozolomide (TMZ) is an alkylating chemotherapeutic agent that has recently been used in some cases as a new therapeutic tool for pituitary carcinomas and aggressive pituitary adenomas. In this report, we present the case of effective TMZ treatment in a 42-year-old man with ACTH-secreting carcinoma. The tumor grew progressively over 4 years, from 2.2 to 31.1 cm3, despite three surgical approaches and gamma-knife treatment. Ki-67 increased from 2 to 18%. An intradural metastasis at the foramen magnum was detected by MRI after the third operation. Thereafter, four cycles of 5-day TMZ administration (200 mg/m2/day during the first, and 150 mg/m2/day during the following cycles) induced dramatic tumor size reduction (>90%). Clinical conditions improved progressively and, after 17 months from the beginning of TMZ administration, the patient is still alive. The treatment was well tolerated except for a transient thrombocytopenia (grade 4 WHO).