Mifepristone (RU 486) treatment of meningiomas

Abstract

Meningiomas are common brain tumours which are generally benign, well circumscribed and slow growing. In a minority of patients complete surgical removal is not possible and re-growth of tumour tissue is a major clinical problem. Most meningiomas contain progesterone receptors. The anti-progestational drug mifepristone (RU 486) binds to these receptors. Ten patients were treated with 12 recurrent or primary "inoperable" meningiomas, all of whom had shown recent neuroradiological and/or ophthalmological evidence of tumour growth. They received 200 mg mifepristone daily for 12 months. Most patients initially had complaints of nausea, vomiting and/or tiredness. In four patients prednisone (7.5 mg/day) was given after which these side-effects subsided. CT scan analysis of tumour size, showed progression of growth of five meningiomas in four patients, stable disease in three patients with three tumours and regression of four tumours in three patients. A decrease in the complaints of headache and an improved general well being was observed in five patients. Two patients died during the treatment period from unrelated causes. Mifepristone treatment resulted in control of tumour growth (= stable disease) in six of 10 patients who had shown recent evidence of tumour growth. In three of these six patients consistent tumour shrinkage was observed.

PIP: Meningiomas are common brain tumors which are generally benign, well circumscribed, and slow growing. In a minority of patients, complete surgical removal is not possible and regrowth of tumor tissue is a major clinical problem. Most meningiomas contain progesterone receptors and the antiprogestational drug mifepristone (RU 486) binds to these receptors. 10 patients were treated with 12 recurrent or primary inoperable meningiomas, all of whom had shown recent neuroradiological and/or ophthalmological evidence of tumor growth. They received 200 mg mifepristone daily for 12 months. Most patients initially had complaints of nausea, vomiting, and/or tiredness. In 4 patients, prednisone (7.5 mg/day) was given, after which these side effects subsided. CT scan analysis of tumor size showed a progression of growth of 5 meningiomas in 4 patients, stable disease in 3 with 3 tumors, and regression of 3 tumors in 3 patients. A decrease in the complaints of headache and an improved general well being was observed in 5 patients. 2 patients died during the treatment period from unrelated causes. Mifepristone treatment resulted in control of tumor growth (stable disease) in 6 of 10 patients who had shown recent evidence of tumor growth. In 3 of these 6 patients, consistent tumor shrinkage was seen.