Meningioma enlargement associated with luteinizing hormone-releasing hormone agonist therapy: two cases and supporting in vitro evidence.
Caution is warranted when initiating LHRH agonist therapy in patients with known or suspected meningiomas, as it may be associated with tumor growth.
Where it sits
this study against the rest of the leuprorelin corpusSummary and findings
This study describes two cases of meningioma enlargement associated with the initiation of leuprorelin acetate therapy. Case 1 involved a 67-year-old man whose tumor accelerated in growth after 26 months, while Case 2 involved a 72-year-old man whose tumor regrew rapidly after 6 years of stability. Both tumors were confirmed to be LHRH and LHRH receptor positive.
Abstract
Luteinizing hormone-releasing hormone (LHRH) agonists are widely used for androgen-deprivation therapy in prostate cancer. Recent reports have raised concern that LHRH may influence the biological behavior of LHRH receptor-expressing intracranial tumors, including meningiomas; however, clinical evidence remains limited. We describe two cases of rapidly progressive meningioma temporally associated with the initiation of leuprorelin acetate. Case 1 was a 67-year-old man with a left cerebellopontine angle meningioma that had demonstrated gradual enlargement over 26 months. Following the initiation of leuprorelin acetate, the tumor exhibited accelerated growth, necessitating surgical resection. Pathology confirmed a fibrous meningioma with LHRH and its receptor positive. Case 2 was a 72-year-old man previously treated with subtotal resection and radiotherapy for an atypical meningioma. After 6 years of radiographic stability, the tumor rapidly regrew soon after leuprorelin acetate initiation and required re-resection. Both the primary and recurrent tumors were LHRH- and LHRH receptor-positive. Freshly resected tumor tissue cultured ex vivo demonstrated a dose-dependent increase in cell viability following 7-day exposure to leuprorelin acetate. These findings suggest that LHRH agonists may be associated with increased cell viability in a subset of receptor-positive meningiomas. Caution is warranted when initiating LHRH agonist therapy in patients with known or suspected meningiomas.
Background
This paper addresses the potential influence of luteinizing hormone-releasing hormone (LHRH) agonists on the biological behavior of LHRH receptor-expressing intracranial tumors, specifically meningiomas. Prior reports have raised concerns about the effects of LHRH therapy on tumor growth, but clinical evidence has been limited. Understanding this relationship is crucial for managing patients undergoing androgen-deprivation therapy for prostate cancer who may also have meningiomas.
Methods
The study presents two case reports of meningioma patients. Case 1 involved a 67-year-old man with a left cerebellopontine angle meningioma, and Case 2 involved a 72-year-old man with a history of atypical meningioma. Both cases were observed for tumor behavior following the initiation of leuprorelin acetate therapy. The primary outcome was tumor growth rate, and secondary outcomes included tumor pathology and cell viability in ex vivo cultures.
Results
In Case 1, the tumor showed accelerated growth necessitating surgical resection after the initiation of leuprorelin acetate. In Case 2, the tumor rapidly regrew after 6 years of stability following the same treatment. Both tumors were confirmed to be LHRH and LHRH receptor positive. Additionally, ex vivo cultures demonstrated a dose-dependent increase in cell viability after exposure to leuprorelin acetate.
Interpretation
These findings suggest a potential association between LHRH agonist therapy and increased viability in LHRH receptor-positive meningiomas. However, the effect sizes observed in these case reports are not statistically quantified, limiting the clinical significance of the findings. The small sample size and lack of controlled studies introduce confounding factors that may affect the conclusions drawn. Caution is warranted when considering LHRH therapy in patients with meningiomas.
Key findings
- Case 1: tumor exhibited accelerated growth necessitating surgical resection after initiation of leuprorelin acetate.
- Case 2: tumor rapidly regrew soon after leuprorelin acetate initiation and required re-resection.
- Both primary and recurrent tumors were LHRH- and LHRH receptor-positive.
- Ex vivo culture showed a dose-dependent increase in cell viability following 7-day exposure to leuprorelin acetate.
Limitations
- Only two case reports presented.
- No statistical analysis of effect sizes reported.
- Lack of control group limits conclusions.
- Short follow-up in individual cases.
- Not applicable for broader patient populations.