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Recurrent meningioma

Salvage therapy with long-acting somatostatin analogue

From the Department of Interdisciplinary Oncology (M.C.C.), H. Lee Moffitt Cancer Center, Tampa, FL, Departments of Oncology, Neurosurgery, and Neurology (M.J.G.), University of Utah/Huntsman Cancer Institute, Salt Lake City, and Division of Hematology/Oncology (C.E.F.), Department of Medicine, Dartmouth Medical School, Lebanon, NH.

Address correspondence and reprint requests to Dr Chamberlain, Department of Neurology, University of Washington, Seattle Cancer Care Alliance, 825 Eastlake Avenue East, M/S G6800, Seattle, WA 98109 chambemc{at}u.washington.edu

Background: Somatostatin receptors, especially the sst2A subtype, are present on most meningiomas. The addition of somatostatin inhibits meningioma growth in vitro in some studies. There have been anecdotal reports of octreotide inhibiting growth in meningiomas.

Objectives: A prospective pilot trial of sustained-release somatostatin (Sandostatin LAR) in 16 patients with recurrent meningiomas was conducted with a primary study objective of progression-free survival at 6 months.

Methods: Sixteen patients (11 women, 5 men; median age 58) with recurrent meningioma were treated prospectively with long-acting somatostatin. Patients had progressed radiographically after prior therapy with surgery (14/16; complete resection in 5; subtotal in 7; biopsy only in 2), radiotherapy (13/16), and chemotherapy (12/16). All patients had confirmation of the presence of somatostatin receptors in their tumor using ¹¹¹In-octreotide, a long-acting somatostatin agonist, SPECT scanning.

Results: Patients received 2 to 15 cycles (median 4.5) of somatostatin with minimal toxicity. Four partial responses, five stable disease, and seven progressive disease patterns were seen. Duration of response ranged from 2 to 20+ months (median 5.0 months). Median survival was 7.5 months (range 3 to 20+). The overall progression-free survival was 44% (seven patients) at 6 months.

Conclusions: In this small trial of patients with recurrent meningiomas shown to overexpress somatostatin receptors by octreotide scintigraphy, long-acting somatostatin (Sandostatin LAR) was administered on a monthly schedule. Thirty-one percent of patients demonstrated a partial radiographic response and 44% achieved progression-free survival at 6 months. Toxicity was minimal, suggesting somatostatin analogues may offer a novel, relatively nontoxic alternative treatment for recurrent meningiomas.

Disclosure: Dr. Chamberlain has received honoraria from Schering-Plough, ENZON, Mundipharma, and MGI. Dr. Glantz has received honoraria from Schering-Plough, ENZON, Mundipharma, and Pharmacyclics. Dr. Fadul has nothing to disclose.

Received January 11, 2007. Accepted in final form April 5, 2007.