Sphenoid Wing Meningioma Medication

Updated: Nov 11, 2016
  • Author: Bhupendra C K Patel, MD, FRCS; Chief Editor: Hampton Roy, Sr, MD  more...
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Medication

Medication Summary

Tamoxifen, an antiestrogen hormone, inhibits the effects of estrogen by competitively binding to estrogen receptor, producing a nuclear complex that decreases DNA synthesis and inhibits estrogen effects. Its use has been reported in small series of patients with refractory or unresectable meningiomas; in one study, 19 patients were included in a phase II trial. Results showed partial MRI response in 3 patients, 6 patients remained stable for a median duration of 31 months, and 10 patients had progression. [88]

Mifepristone, RU-486 (Mifeprex), is an antiprogesterone agent. A 2015 systematic review of all studies reporting on this medication did not provide any evidence for benefit beyond preclinical uses. [89]

Hydroxyurea is a chemotherapeutic agent that selectively inhibits ribonucleoside diphosphate reductase and induces apoptosis. Small case series of patients with recurrent grade II and III meningiomas have been published. Some of the these studies suggest clinical stabilization of the disease with radiological response except in one patient. [90]

Sunitinib is a tyrosine kinase inhibitor that targets VEGFR and PDGF receptor. A prospective, multicenter, single-arm phase II trial of 36 patients with recurrent WHO II and III meningioma found 42% progression-free survival at 6 months, with 5.2 months median progression-free survival and 24.6 months median overall survival. This study demonstrated that expression of VEGFR2 predicted progression-free survival of a median of 1.4 months in VEGFR2-negative patients versus 6.4 months in VEGFR2-positive patients, suggesting that VEGFR2 might be an important prognosticator in WHO II/III meningioma. [91]

Other systemic therapies have been evaluated for recurrent meningioma including cytotoxic chemotherapies (temozolomide, irinotecan, and combination therapy with cyclophosphamide, doxorubicin, and vincristine), biologics (interferon alfa-2b), and targeted therapies (erlotinib, gefitinib, somatostatin analogs, sunitinib, valatinib, imatinib, bevacizumab).

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Estrogen antagonists

Class Summary

Inhibit effects of estrogen by competitively binding to estrogen receptor.

Tamoxifen (Soltamox)

Competitively binds to estrogen receptor, producing a nuclear complex that decreases DNA synthesis and inhibits estrogen effects.

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Progesterone antagonists

Class Summary

RU-486 has been used experimentally in the treatment of this medical condition.

Mifepristone, RU-486 (Korlym, Mifeprex)

Experimental antiprogesterone agent. Used in patients with recurrent benign meningiomas; in one study of 14 patients, tumor regression was reported in 5 of 14 patients.

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Antineoplastics, VEGF Inhibitor

Class Summary

Agents in this class inhibit cell growth and proliferation and exhibit antiangiogenic properties.

Sunitinib (Sutent)

This agent shows antitumor and antiangiogenic effects. May inhibit multiple-receptor tyrosine kinases, including platelet-derived growth factors, vascular endothelial growth factors, FMS-like tyrosine kinase-3, colony-stimulating factor type 1, and glial cell-line–derived neurotrophic factor receptor. Studies have shown that VEGFR2-positive patients may achieve progression-free survival of up to 6.4 months.

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