Effectiveness of long-term cabergoline treatment for giant prolactinoma: study of 12 men

Objective: To review our experience with cabergoline, a D2-selective dopamine agonist, for the treatment of giant prolactinomas. Design: A retrospective case series; descriptive statistics. Methods: The study group included 12 men aged 24–52 years (mean 39.2 years) treated for giant prolactinoma at our centers from 1997 to 2006. Cabergoline was started at a dose of 0.5 mg/three times a week and progressively increased as necessary to up to 7 mg/week. Patients were followed by hormone measurements, sellar magnetic resonance imaging, and visual examinations. Results: In ten patients, cabergoline served as first-line therapy. The other two patients had previously undergone transsphenoidal partial tumor resection because of visual deterioration. Mean serum prolactin level before treatment was 14 393 ± 14 579 ng/ml (range 2047–55 033 ng/ml; normal 5–17 ng/ml). Following treatment, levels normalized in ten men within 1–84 months (mean, 25.3 months) and decreased in the other two to 2–3 times of normal. Tumor diameter, which measured 40–70 mm at diagnosis, showed a mean maximal decrease of 47 ± 21%; response was first noted about 6 months after the onset of treatment. Nine patients had visual field defects at diagnosis; vision returned to normal in three of them and improved in five. Testosterone levels, initially low in all patients, normalized in eight. There were no side effects of treatment. Conclusion: Cabergoline therapy appears to be effective and safe in men with giant prolactinomas. These findings suggest that cabergoline should be the first-line therapy for aggressive prolactinomas, even in patients with visual field defects.

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Hepatic reserve and the other conditions for regorafenib as second-line treatment in patients with advanced hepatocellular carcinoma following first-line therapy with sorafenib in Japanese practical setting

Annals of Oncology ◽

10.1093/annonc/mdx660.047 ◽

2017 ◽

Vol 28 ◽

pp. x71

Author(s):

T. Terashima ◽

T. Yamashita ◽

K. Arai ◽

S. Kaneko

Keyword(s):

Hepatocellular Carcinoma ◽

The Other ◽

Advanced Hepatocellular Carcinoma ◽

Line Treatment ◽

Second Line ◽

First Line ◽

Hepatic Reserve ◽

First Line Therapy ◽

Line Therapy

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Bichat guidelines for the clinical management of plague and bioterrorism-related plague

Eurosurveillance ◽

10.2807/esm.09.12.00501-en ◽

2004 ◽

Vol 9 (12) ◽

pp. 23-24 ◽

Cited By ~ 4

Author(s):

P Bossi ◽

A Tegnell ◽

A Baka ◽

F van Loock ◽

A Werner ◽

...

Keyword(s):

Antibiotic Prophylaxis ◽

Yersinia Pestis ◽

Antibiotic Treatment ◽

Clinical Management ◽

The Other ◽

First Line ◽

Rodent Population ◽

First Line Therapy ◽

Line Therapy ◽

Therapeutic Guidelines

Yersinia pestis appears to be a good candidate agent for a bioterrorist attack. The use of an aerosolised form of this agent could cause an explosive outbreak of primary plague pneumonia. The bacteria could be used also to infect the rodent population and then spread to humans. Most of the therapeutic guidelines suggest using gentamicin or streptomycin as first line therapy with ciprofloxacin as optional treatment. Persons who come in contact with patients with pneumonic plague should receive antibiotic prophylaxis with doxycycline or ciprofloxacin for 7 days. Prevention of human-to-human transmission via patients with plague pneumonia can be achieved by implementing standard isolation procedures until at least 4 days of antibiotic treatment have been administered. For the other clinical types of the disease, patients should be isolated for the first 48 hours after the initiation of treatment.

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Abstract #349: A Case Of A Giant Prolactinoma Presenting With Visual Field Defects Responsive To Bromocriptine Therapy

Endocrine Practice ◽

10.1016/s1530-891x(20)44093-5 ◽

2006 ◽

Vol 12 ◽

pp. 10-11

Author(s):

Janet Myra Noel ◽

Lynn Kessler

Keyword(s):

Visual Field ◽

Visual Field Defects ◽

Giant Prolactinoma ◽

Field Defects

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Complex visual hallucinations (Charles Bonnet syndrome) in visual field defects following cerebral surgery

Journal of Neurosurgery ◽

10.3171/jns.2004.101.5.0846 ◽

2004 ◽

Vol 101 (5) ◽

pp. 846-853 ◽

Cited By ~ 21

Author(s):

Thomas M. Freiman ◽

Rainer Surges ◽

Vassilios I. Vougioukas ◽

Ulrich Hubbe ◽

Jochen Talazko ◽

...

Keyword(s):

Visual Field ◽

Visual Hallucination ◽

The Other ◽

Visual Field Defects ◽

Neurosurgical Procedures ◽

Visual Hallucinations ◽

Content Type ◽

Charles Bonnet Syndrome ◽

Fine Print ◽

Field Defects

✓ The development of visual hallucinations after loss of vision is known as the Charles Bonnet syndrome. This phenomenon was first described in 1760 by Charles Bonnet and others during their observations of elderly patients with degeneration of the retina or cornea. To date a clear association between visual hallucinations and neurosurgical procedures has not been reported. Because of their clear demarcation, however, surgical lesions in the cerebrum offer a unique opportunity to determine the pathoanatomical aspects of visual hallucinations. During a 3-year period, 41 consecutive patients who acquired visual field defects after neurosurgery were examined for the occurrence of visual hallucination. Postoperatively, four of these patients experienced visual hallucinations. In two of them an upper quadrantanopia developed after the patients had undergone selective amygdalohippocampectomy. In the other two patients a complete hemianopia developed, in one case after resection of a parietal astrocytoma and in the other after resection of an occipital glioblastoma multiforme. The visual hallucinations were transient and gradually disappeared between 4 days and 6 months postoperatively. The patients were aware of the fact that their hallucinations were fictitious and displayed no psychosis. Electroencephalographic recordings were obtained in only two patients and epileptic discharges were found. Deafferentiation of cortical association areas may lead to the spontaneous generation of complex visual phenomena. In the present series this phenomenon occurred in approximately 10% of patients with postoperative visual field defects. In all four cases the central optic radiation was damaged between the lateral geniculate nucleus and the primary visual cortex. The complex nature of the visual hallucination indicates that they were generated in visual association areas.

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From headache to Rathke’s cleft cyst followed by diabetes insipidus with panhypopituitarism

ARS Medica Tomitana ◽

10.1515/arsm-2015-0035 ◽

2015 ◽

Vol 21 (3) ◽

pp. 137-140

Author(s):

Ana Valea ◽

Alexandra Marcusan ◽

Mara Carsote ◽

Adina Ghemigian ◽

Cristina Ghervan ◽

...

Keyword(s):

Visual Field ◽

Diabetes Insipidus ◽

Serum Prolactin ◽

Visual Field Defects ◽

Rathke’S Cleft Cyst ◽

Rathke's Cleft Cyst ◽

Central Hypothyroidism ◽

Iatrogenic Complications ◽

Rathke's Cleft ◽

Field Defects

ABSTRACT Introduction The Rathke cyst represents an unusual benign tumour derived from Rathke’s cleft remnants. The diagnosis is potential seen at any age. The most frequent signs are mostly mass effects as headache, visual field defects and hypopituitarism. Case presentation 30-year old female is admitted for persistent headache that was later associated with secondary amenorrhea and visual field defects for the last two years. The clinical data are consistent with high levels of serum prolactin, gonadotropes deficiency, as well as central hypothyroidism. The magnetic resonance imagery found a pituitary tumour of 2.7 centimetres with extrapituitary extension up to the optic chiasm. Surgery was performed in order to remove the tumour. The pathologic report confirmed a Rathke’s cleft cyst. Diabetes insipidus associated with panhypopituitarism was diagnosed and treated after the procedure. Close follow-up is necessary. Conclusion This case highlights the fact that headache sometimes embraces a severe neoplasia diagnosis and that the iatrogenic complications after surgery are lifelong care demanding

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Clinical Option of Pemetrexed-Based Versus Paclitaxel-Based First-Line Chemotherapeutic Regimens in Combination With Bevacizumab for Advanced Non-Squamous Non-Small-Cell Lung Cancer and Optimal Maintenance Therapy: Evidence From a Meta-Analysis of Randomized Control Trials

10.21203/rs.3.rs-43694/v1 ◽

2020 ◽

Author(s):

Le-Tian Huang ◽

Rui Cao ◽

Yan-Ru Wang ◽

Li Sun ◽

Xiang-Yan Zhang ◽

...

Keyword(s):

Maintenance Treatment ◽

Meta Analysis ◽

Small Cell ◽

The Other ◽

Small Cell Lung ◽

First Line ◽

First Line Therapy ◽

Line Therapy ◽

Oncogenic Driver ◽

Grade 3

Abstract Background: In the era of immunotherapy, it is still unclear which is the best first-line therapy for patients with oncogenic driver negative advanced non-squamous non-small cell lung cancer (NS-NSCLC) who cannot tolerate immunotherapy, or subsequent therapy for patients with oncogenic driver positive NS-NSCLC whose disease progressed on prior targeted therapy. To assess the optimal choice of first-line and maintenance treatment regimens, we performed a meta-analysis of prospective randomized controlled clinical trials (RCTs) of patients with NS-NSCLC on bevacizumab combined with chemotherapy. Methods: All eligible RCTs comparing pemetrexed-platinum with or without bevacizumab (PP±B) and paclitaxel-carboplatin with bevacizumab (PC+B) as a first-line therapy, or comparing bevacizumab plus pemetrexed (Pem+B) and bevacizumab alone (B) as a maintenance treatment for advanced NS-NSCLC, were included after systematically searching web databases and meeting abstracts. The main research endpoints were comparisons of overall survival (OS) and progression-free survival (PFS). The other endpoints were objective response rate (ORR), 1-year PFS rate (PFSR1y) and major grade 3/4 treatment-related adverse events.Results: Data of 3,139 patients from six RCTs were incorporated into analyses. Three RCTs were included in an analysis that compared PP±B and PC+B as a first-line therapy for advanced NS-NSCLC. Patients treated with first-line PP±B showed similar OS and ORR, but significantly improved PFS (hazard ratio [HR], 0.88) and PFSR1y (risk ratio [RR], 0.83), as compared to patients treated with PC+B (all P<0.05). PP±B resulted in higher rates of grade 3/4 anemia and thrombocytopenia, but lower rates of neutropenia, febrile neutropenia, and sensory neuropathy than PC+B (all P<0.001). The other three RCTs were included in an analysis that compared Pem+B and B as a maintenance treatment. Compared with B, Pem+B maintenance treatment resulted in significant improvements in OS (HR, 0.88), PFS (HR, 0.64), and PFSR1y (RR, 0.70), but higher rates of anemia, thrombocytopenia, and neutropenia (all P<0.001).Conclusion: Although the first-line PP+B regimen had longer PFS and PFSR1y than the PC+B regimen, no OS difference was observed. Addition of pemetrexed to bevacizumab as maintenance therapy significantly improved OS compared with bevacizumab maintenance alone, but led to more toxicity.

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Patterns of imatinib resistance mutation analysis in chronic myeloid leukemia (CML) patients on imatinib at the time of loss of response to the drug in Asian Indian subjects

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.7079 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 7079-7079

Author(s):

K. Prabhash ◽

T. Vora ◽

N. S. Ghadyalpatil ◽

B. Rangarajan ◽

S. S. Hingmire ◽

...

Keyword(s):

Drug Resistance ◽

Mutation Analysis ◽

Resistance Mutation ◽

The Other ◽

Molecular Response ◽

First Line ◽

Imatinib Resistance ◽

Loss Of Response ◽

First Line Therapy ◽

Line Therapy

7079 Background: The treatment of (CML) has undergone major changes in the past decade with the introduction of tyrosine kinase inhibitors (TKI). However the initial enthusiasm is waning with increasing recognition of drug resistance. There is an urgent need to identify the types of receptor mutations which lead to drug resistance and their significance in salvage therapy. Methods: We identified 17 males and 8 female patients with median age 40 yrs (range 9–55 years) with CML who were on imatinib at the time of loss of hematologic response (HR), cytogenetic (CyR), or molecular response (MR) and performed imatinib-resistance mutation analysis. The sequencing was done on ABI machine by direct sequencing method. Results: This group included 22 patients with chronic phase (CP) disease, 2 patients with accelerated phase (AP), and 1 patient with extramedullary blast crisis (BC). Fourteen patients received treatment with agents other than imatinib as the first-line therapy due to either nonavailability of the drug at the time of diagnosis in India, but were started on imatinib when drug became available. The other 11 patients received imatinib as first-line therapy. The best response to imatinib included major CyR in 14 patients which included 3 patients with complete CyR and minor CyR in 6 patients. Lack of HR was noted in 2 patients in whom CyR was not evaluated. Imatinib resistance mutation analysis was prompted by no HR (n = 2); loss of HR after achieving CyR (n = 9); failure to achieve CyR milestones (n = 3); loss of CyR (n = 9); development of extramedullary BC (n = 1). The analysis revealed no mutations-11 patients, M351T-4 patients, G250E-3 patients, F317L-2 patients, M244V- 1 patient, T315I-1 patient, F382L-1 patient, results awaited in 4 patients with 2 patients showing 2 mutations. Conclusions: The majority of patients 11/25 had no detectable mutations while T315I which confers resistance to all TKIs was detected only in 1/25 patients who demonstrated loss of response in our population. The correlation of the other mutations to loss of response and the response to second line TKI needs to be studied in further detail. In addition analysis of mutation patterns at baseline may help in stratifying patients for treatment. No significant financial relationships to disclose.

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Reduced Visual Field Activity Due to Covid-19 in a Patient With a Pituitary Macroadenoma

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1237 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A607-A607

Author(s):

Matthew Norman Rosner ◽

Ribal Al Aridi

Keyword(s):

Visual Field ◽

Visual Fields ◽

Serum Prolactin ◽

Pituitary Macroadenoma ◽

Surgical Interventions ◽

First Line Therapy ◽

Vertebrobasilar System ◽

Ophthalmic Manifestations ◽

Field Defects ◽

Transsphenoidal Resection

Abstract Background: Vision changes can be the presenting symptom of pituitary macroadenomas. The first-line therapy is transsphenoidal resection except for macroprolactinomas where medical therapy with dopamine agonist (DA) is the initial treatment of choice. Surgical resection is reserved if treatment with DA did not result in decreased serum prolactin (PRL), size of adenoma and/or alleviation of symptoms. With the Covid-19 pandemic, there have been a variety of symptoms reported including ophthalmic manifestations (1). We will present how an acute decrease in vision from Covid-19 nearly led to surgical intervention of macroprolactinoma. Clinical Case: A 61-year-old woman presented to the emergency room (ER) with complaints of headache in 6/2020. MRI Brain showed a 4.0 x 4.0 x 4.5 cm pituitary macroadenoma with suprasellar extension and invasion of the cavernous sinuses. The mass engulfed the adjacent circle of Willis, the MCAs bilaterally, the PCAs and the superior aspect of the vertebrobasilar system. Initial PRL was 7441 ng/mL (5.2-26.25 ng/mL). She was discharged on Cabergoline 0.25 mg twice weekly. Visual field exam showed mild nonspecific field defects in the right eye and larger diffuse field defects in the left eye slightly more temporal. One month later, Cabergoline dose was increased to 0.5 mg twice weekly with PRL drop to 1161.7 ng/mL. In 8/2020, she started to complain of worsening vision. Ophthalmological exam showed worsening visual fields in both eyes and the optic discs showed temporal pallor. She was referred to ER where she tested positive for Covid-19 and was admitted. CT Head showed stable partially calcified enhancing sellar and suprasellar mass. Repeat PRL was 635.6 ng/mL. Despite reduction in PRL, transsphenoidal resection was considered but was deferred to 9/2020 due to Covid-19. Follow up appointment with Neuro-ophthalmology in 9/2020 prior to scheduled surgery, showed visual field improvement with just mild nonspecific defects and surgery was canceled. PRL in 10/2020 decreased to 239.1 ng/mL. Patient’s visual fields continued to improve after recovery from Covid-19 and with reduction in PRL. It was determined that the patient’s reduction in visual fields was due to Covid-19 and not her macroadenoma. Conclusion: There have not been many reported cases of decreased visual fields due to Covid-19 (1). Proposed mechanisms include expression of ACE-2 receptors in the aqueous humor, which is the main receptor for Covid-19, and thromboembolic disease (1). More studies and data are needed to conclude the mechanism of decreased visual fields. This will avoid unnecessary surgical interventions for patients with macroprolactinomas. References: 1. Ho, D., Low, R., Tong, L., et al. COVID-19 and the Ocular Surface: A Review of Transmission and Manifestations. Ocul Immunol Inflamm. 2020 Jul 3;28(5):726-734.

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Clinical option of pemetrexed-based versus paclitaxel-based first-line chemotherapeutic regimens in combination with bevacizumab for advanced non-squamous non-small-cell lung cancer and optimal maintenance therapy: evidence from a meta-analysis of randomized control trials

BMC Cancer ◽

10.1186/s12885-021-08136-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Le-Tian Huang ◽

Rui Cao ◽

Yan-Ru Wang ◽

Li Sun ◽

Xiang-Yan Zhang ◽

...

Keyword(s):

Maintenance Treatment ◽

Meta Analysis ◽

Small Cell ◽

The Other ◽

Small Cell Lung ◽

First Line ◽

First Line Therapy ◽

Line Therapy ◽

Oncogenic Driver ◽

Grade 3

Abstract Background In the era of immunotherapy, it is still unclear which is the best first-line therapy for patients with oncogenic driver negative advanced non-squamous non-small cell lung cancer (NS-NSCLC) who cannot tolerate immunotherapy, or subsequent therapy for patients with oncogenic driver positive NS-NSCLC whose disease progressed on prior targeted therapy. To assess the optimal choice of first-line and maintenance treatment regimens, we performed a meta-analysis of prospective randomized controlled clinical trials (RCTs) of patients with NS-NSCLC on bevacizumab combined with chemotherapy. Methods All eligible RCTs comparing pemetrexed-platinum with or without bevacizumab (PP ± B) and paclitaxel-carboplatin with bevacizumab (PC + B) as a first-line therapy, or comparing bevacizumab plus pemetrexed (Pem + B) and bevacizumab alone (B) as a maintenance treatment for advanced NS-NSCLC, were included after systematically searching web databases and meeting abstracts. The main research endpoints were comparisons of overall survival (OS) and progression-free survival (PFS). The other endpoints were objective response rate (ORR), 1-year PFS rate (PFSR1y) and major grade 3/4 treatment-related adverse events. Results Data of 3139 patients from six RCTs were incorporated into analyses. Three RCTs were included in an analysis that compared PP ± B and PC + B as a first-line therapy for advanced NS-NSCLC. Patients treated with first-line PP ± B showed similar OS and ORR, but significantly improved PFS (hazard ratio [HR], 0.88) and PFSR1y (risk ratio [RR], 0.83), as compared to patients treated with PC + B (all P < 0.05). PP ± B resulted in higher rates of grade 3/4 anemia and thrombocytopenia, but lower rates of neutropenia, febrile neutropenia, and sensory neuropathy than PC + B (all P < 0.001). The other three RCTs were included in an analysis that compared Pem + B and B as a maintenance treatment. Compared with B, Pem + B maintenance treatment resulted in significant improvements in OS (HR, 0.88), PFS (HR, 0.64), and PFSR1y (RR, 0.70), but higher rates of anemia, thrombocytopenia, and neutropenia (all P < 0.001). Conclusion Although the first-line PP + B regimen had longer PFS and PFSR1y than the PC + B regimen, no OS difference was observed. Addition of pemetrexed to bevacizumab as maintenance therapy significantly improved OS compared with bevacizumab maintenance alone, but led to more toxicity.

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