UC achieves first-in-world remission of aggressive pituitary tumor with novel immunotherapy

Researchers at the University of Cincinnati's Gardner Neuroscience Institute’s Brain Tumor Center have confirmed that they are the first in the world to achieve complete remission of a rare pituitary cancer using a novel immunotherapy treatment.

The findings were published in Surgical Neurology International and recently featured in The Cancer Letter. 

The research team is calling on the worldwide neurosurgical and neuro-oncology communities to use tumor genomic testing in pituitary carcinomas and aggressive pituitary adenoma to guide consideration for immunotherapy as a potential first-line treatment.

“To date, immunotherapy has revolutionized the care of patients with metastatic melanoma and non-small cell lung cancer, but until recently, they hadn’t been available for patients with aggressive pituitary cancer,” said Jonathan Forbes, associate professor and residency program director in the Department of Neurosurgery in UC’s College of Medicine.

Forbes said tumors involving the pituitary gland at the base of the brain are relatively common, but highly aggressive tumors in this location are rare. When encountered, APAs and PCs are very difficult to treat and have had poor responses to standard treatments, including surgery, radiation and chemotherapy with temozolomide.

Whereas historical agents like temozolomide often indiscriminately target dividing cells, newer “precision” therapies, such as immunotherapy, can selectively target tumor-associated mutations.

In the case study, Forbes and his colleagues detail a patient who presented with visual loss and was found to have a pituitary tumor. The tumor was completely removed with full restoration of vision after surgery.

Pathological testing found the tumor to be incredibly biologically aggressive. The patient received post-operative radiation therapy and remained tumor-free for about a year following surgery.

When the tumor came back, the patient was started on first-line temozolomide, which failed to suppress tumor growth. After additional tumor growth, resulting in multi-focal progressive and double vision, the patient considered hospice before electing to proceed with a clinical trial. 

The team at the UC Brain Tumor Center used tumor genomics to identify a specific mismatch repair mutation, which led them to select a clinical trial they felt was an optimal fit for the patient.

“Following a thorough review of tumor genomics, we were able to get the patient signed up for the right clinical trial,” said Forbes. “Using that scientifically-informed regimen, he was able to clear the cancer. The double vision completely resolved on the immunotherapy regimen. It was the first in the world to have a complete response, meaning the cancer completely vanished and did not return after the medication was stopped.”

Read the full report in The Cancer Letter.

Featured photo at top: CT brain scan. Photo/iStock/Tonpor Kasa.