Preliminary report of patients with meningiomas exposed to Cyproterone Acetate, Nomegestrol Acetate and Chlormadinone Acetate – Monocentric ongoing study on progestin related meningiomas

• Published in: Clinical neurology and neurosurgery 2021-11, Vol.210, p.106959-106959, Article 106959
• Main Authors: Devalckeneer, Antoine, Aboukais, Rabih, Bourgeois, Philippe, De Witte, Olivier, Racape, Judith, Caron, Sabine, Perbet, Romain, Maurage, Claude-Alain, Lejeune, Jean-Paul
• Format: Article
• Language: English
• Subjects: Acetate cyproterone; Acetic acid; Adult; Aged; Brain cancer; Breast cancer; Chlormadinone acetate; Chlormadinone Acetate - adverse effects; Cloning; Cyproterone acetate; Cyproterone Acetate - adverse effects; Edema; Estrogens; Female; Headaches; Humans; Intracranial meningioma; Magnetic Resonance Imaging; Male; Megestrol - adverse effects; Meningeal Neoplasms - chemically induced; Meningeal Neoplasms - diagnostic imaging; Meningeal Neoplasms - pathology; Meningioma; Meningioma - chemically induced; Meningioma - diagnostic imaging; Meningioma - pathology; Middle Aged; Nervous system; Neurology; Nomegestrol acetate; Norpregnadienes - adverse effects; Patients; Progestin; Progestins; Radiation therapy; Retrospective Studies; Software; Statistical analysis; Tumors
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2021.106959

The relationship between meningioma and progestins has not been elucidated. Meningioma regression after acetate cyproterone (CA) withdrawal has been reported. Our purpose was to evaluate the meningioma evolution after withdrawal of progestins in patients who underwent long-term exposure to CA, nomegestrol acetate (NA), chlormadinone acetate (ChlA). Our study retrospectively included 69 patients with intracranial meningioma and exposed to one of these 3 progestins between December 2006 and March 2019. In each patient, clinico-radiological (MRI) follow-up was performed every 6 months after diagnosis and treatment withdrawal recommendation. Statistical analyses were applied to compare tumor location and respect of prescription rules between the 3 groups. The mean hormonal exposure was 16 years in CA group (n = 46), 16 years in NA group (n = 12) and 9.7 years in ChlA group (n = 11). A higher rate of “out of label” use was observed in the CA group (p = 0.003). Multiple meningiomas were demonstrated in more than 60% of cases in each group. Anterior skull base location was noted in 60.5% of cases in CA group, 25% of cases in NA group and 36.7% of cases in ChlA group (p = 0.05). Incomplete tumor regression was recorded in 11 cases of CA group and in 2 cases of ChlA group. In CA group, our results suggest a strong relationship between this treatment and development of intracranial meningioma. In presence of voluminous asymptomatic meningioma, treatment can be delayed due to the potential regression after withdrawal. On the contrary in NA and ChlA groups, further studies are needed.