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Published on: January 17, 2018
Effect of cabergoline on tumor remnant after surgery in nonfunctioning pituitary adenoma
Pedro Iglesias1, Betina Biagetti2, Marta Araujo-Castro3
1Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda (Majadahonda), Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana (IDIPHISA), Calle Manuel de Falla 1, 28222, Madrid, Spain. piglo65@gmail.com.
Background:
In recent years, dopamine agonists (DAs) have become an attractive therapeutic option to prevent both tumor growth and post-surgical tumor remnant growth in clinically non-functioning pituitary adenoma (NFPA).
Aim:
To analyze our experience on the effect of cabergoline (CAB) on tumor remnant after initial surgery in NFPA patients.
Patients And Methods:
A retrospective and multicenter study of NFPA patients with tumor remnant after surgery treated with CAB was performed.
Results:
From a total of 142 NFPA patients (79 men, 55.2%; mean age 57.2 ± 14.2 year) who underwent surgery, we selected 62/142 (43.7%) patients (32 men, 51.6%; mean age 59.3 ± 13.9 year) with tumor persistence (TP) after surgery. In 22/62 (35.5%) TP patients CAB was used (CAB group), while the rest of the patients (40/62, 64.5%) underwent active surveillance [observation (OBS) group)]. The maximum diameter of the tumor remnant did not change significantly in either the CAB group [11.5 (6.0-16.9) mm vs. 12.0 (7.0-15.0) mm, p = 0.85) or the OBS group [8.5 (6.0-13.7) mm vs. 9.0 (6.2-14.0) mm, p = 0.064) at the end of the follow-up [13 (10.5-17) vs. 77.5 (50.2-107.2) months, CAB vs. OBS group; p < 0.001]. At the end of the treatment period with CAB most of the patients (n = 20/22, 90.9%) showed no progression of the tumor remnant [stable disease, SD (n = 17/22, 77.2%) and partial response, PR (n = 3/22, 13.6%)], while 2/22 patients (9.1%) exhibited progression. Similar response rates were observed in the OBS group [SD (n = 32/40, 80%), PR (n = 2/40, 5%), and progression (n = 6/40, 15%)]. Although no statistically significant differences (p = 0.42) were found in these responses, the percentage of progression was 1.65 times higher in the OBS group compared to the CAB group. On the contrary, the percentage of PR was 2.72 times higher in the CAB group compared to the OBS group, despite a significantly shorter follow-up period in the CAB group.
Conclusion:
Although the present study showed no significant differences in the type of tumor response between the CAB and OBS groups of patients, the percentage of PR was higher and that of progression lower in the CAB group compared to the OBS group. This finding does not rule out a potential therapeutic benefit of CAB in the management of tumor remnant in patients with NFPA undergoing surgery.
Insights
Cabergoline (CAB) may offer a therapeutic benefit for non-functioning pituitary adenoma (NFPA) tumor remnants after surgery. While not statistically significant, CAB treatment showed a higher partial response rate and lower progression rate compared to observation alone.
Area of Science:
- Endocrinology
- Neurosurgery
- Oncology
Background:
- Dopamine agonists (DAs) are increasingly used to manage non-functioning pituitary adenoma (NFPA) tumor growth.
- Their role in preventing post-surgical tumor remnant growth in NFPA warrants further investigation.
Purpose of the Study:
- To evaluate the efficacy of cabergoline (CAB) in managing residual tumor after initial surgery for NFPA.
- To compare CAB treatment with active surveillance for persistent NFPA tumor remnants.
Main Methods:
- Retrospective, multicenter study of NFPA patients with tumor persistence post-surgery.
- Patients were divided into two groups: cabergoline (CAB) treatment and observation (OBS).
- Tumor remnant size and response were assessed over time.
Main Results:
- No significant change in maximum tumor remnant diameter was observed in either the CAB or OBS group.
- The CAB group showed a higher partial response (PR) rate (13.6%) and a lower progression rate (9.1%) compared to the OBS group (PR: 5%, Progression: 15%).
- Despite a shorter follow-up, CAB treatment demonstrated a trend towards better tumor control.
Conclusions:
- While statistical significance was not reached, cabergoline (CAB) demonstrated a trend towards improved outcomes in managing NFPA tumor remnants.
- The higher partial response and lower progression rates in the CAB group suggest a potential therapeutic benefit.
- Further research is needed to confirm the role of CAB in NFPA remnant management.
