Sandostatin for meningioma – pro
Several preclincial reports and a small phase Ii study recently been published suggesting activity of Sandostatin in meningioma. 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.
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. 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.
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.
This a prelimianry study that needs repeatition and validation. Numerous treatmetn alternaives formeingioma are available. To date, surgical resection is the mainstay of meningioma therapy. The completeness of the resection is the single most important prognostic factor for recurrence. In case of incomplete resection or recurrence, radiation therapy with 54 Gy (1.8 to 2 Gy/fraction) yields comparable results to total resection. Radiosurgery is a valuable alternative to radiotherapy (RT), maybe in the future also for surgery, as recently demonstrated. In the rare meningioma patients, that have exhausted the possibilities of surgery and RT, there have been some successful small series using hydroxyurea or interferon alpha.
Future therapeutic options might consist in octreotide isotopic therapy or targeted therapy directed against tumour neo-angiogenesis or other proliferation associated markers in meningiomas. However, at this time it should be considered investigational.Marc C. Chamberlain, MD, Michael J. Glantz, MD and Camilo E. Fadul, MD
Salvage therapy with long-acting somatostatin analogue NEUROLOGY 2007;69:969-973
C Marosi, M Hassler, K R ssler
Guidelines for treatment of meningioma, Forum (Genoa, Italy) Vol. 13 Issue 1 Pg. 76-89 2003
McMullen KP, Stieber VW. Meningioma: current treatment options and future directions.
Curr Treat Options Oncol. 2004 Dec;5(6):499-509.