|A meningioma is a
tumour arising from the meninges covering the brain. They account for 15% of all primary
brain tumours. Although meningiomas are generally benign tumours they may kill the patient
in due time by virtue of their intracranial position and by the pressure they exert on the
Currently, the accepted management of these tumours is attempted total surgical excision when technically possible and when associated with an acceptable risk. However, there is a danger of severe or even total haemorrhage. Epidermological evidence, including the greater incidence of female patients, a positive association with pregnancy, and a positive association with breast cancer suggested a role for female sex hormones (and hormonal regulation) in regulating the growth of meningioma.
Meningioma specimens have more often been found positive for progesterone receptors than oestrogen receptors. Modulation of progesterone levels via the progesterone-receptor protein would seem to be a promising strategy for inhibiting meningioma.
Meningioma specimens have more often been found positive for progesterone receptors than oestrogen receptors. Modulation of progesterone levels via the progesterone-receptor protein would seem to be a promising strategy for inhibiting meningioma growth.
Several trials have now indicated an inhibitor action of the anti-progestin mifepristone e.g. oral administration of mifepristone 200mg daily for extended periods to 13 patients with unresectable meningiomas resulted in minor tumour regression in 5 patients and stabilisation of disease in a further 5 patients. 11 of the patients on the trial had shown objective or symptomatic progression before the study.
In another study, mifepristone 200mg daily for 12 months resulted in control of tumour growth in 6 out of 10 patients who had shown recent neuological and/or opthalmological evidence of tumour growth.
Long term therapy has been well tolerated. Adverse events include fatigue, hot flushes, gynaecomastia/ breast tenderness, skin rash, cessation of menses and decrease in libido. Increase in cortisol and TSH (thyroid-stimulating hormone) are the most striking endocrine changes.