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Brichant G, Laraki I, Henry L, Munaut C, Nisolle M. New Therapeutics in Endometriosis: A Review of Hormonal, Non-Hormonal, and Non-Coding RNA Treatments. Int J Mol Sci 2021; 22:10498. [PMID: 34638843 PMCID: PMC8508913 DOI: 10.3390/ijms221910498] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 12/14/2022] Open
Abstract
Endometriosis is defined as endometrial-like tissue outside the uterine cavity. It is a chronic inflammatory estrogen-dependent disease causing pain and infertility in about 10% of women of reproductive age. Treatment nowadays consists of medical and surgical therapies. Medical treatments are based on painkillers and hormonal treatments. To date, none of the medical treatments have been able to cure the disease and symptoms recur as soon as the medication is stopped. The development of new biomedical targets, aiming at the cellular and molecular mechanisms responsible for endometriosis, is needed. This article summarizes the most recent medications under investigation in endometriosis treatment with an emphasis on non-coding RNAs that are emerging as key players in several human diseases, including cancer and endometriosis.
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Affiliation(s)
- Geraldine Brichant
- Obstetrics and Gynecology Department, ULiege, 4000 Liège, Belgium; (I.L.); (L.H.); (M.N.)
| | - Ines Laraki
- Obstetrics and Gynecology Department, ULiege, 4000 Liège, Belgium; (I.L.); (L.H.); (M.N.)
| | - Laurie Henry
- Obstetrics and Gynecology Department, ULiege, 4000 Liège, Belgium; (I.L.); (L.H.); (M.N.)
| | - Carine Munaut
- Laboratory of Tumor and Development Biology, Giga-Cancer, ULiege, 4000 Liège, Belgium;
| | - Michelle Nisolle
- Obstetrics and Gynecology Department, ULiege, 4000 Liège, Belgium; (I.L.); (L.H.); (M.N.)
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Malaize H, Samoyeau T, Zanello M, Roux A, Benzakoun J, Peeters S, Zah-Bi G, Edjlali M, Tauziede-Espariat A, Dezamis E, Parraga E, Chrétien F, Varlet P, Plu-Bureau G, Oppenheim C, Pallud J. Evolution of the neurosurgical management of progestin-associated meningiomas: a 23-year single-center experience. J Neurooncol 2021; 152:279-288. [PMID: 33449307 DOI: 10.1007/s11060-021-03696-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/04/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE The improving knowledge of interactions between meningiomas and progestin refines the management of this specific condition. We assessed the changes over time of the management of progestin-associated meningiomas. METHODS We retrospectively studied consecutive adult patients who had at least one meningioma in the context of progestin intake (October 1995-October 2018) in a tertiary adult Neurosurgical Center. RESULTS 71 adult women with 125 progestin-associated meningiomas were included. The number of progestin-associated meningioma patients increased over time (0.5/year before 2008, 22.0/year after 2017). Progestin treatment was an approved indication in 27.0%. A mean of 1.7 ± 1.2 meningiomas were discovered per patient (median 1, range 1-6). Surgery was performed on 36 (28.8%) meningiomas and the histopathologic grading was WHO grade 1 in 61.1% and grade 2 in 38.9%. The conservative management of meningiomas increased over time (33.3% before 2008, 64.3% after 2017) and progestin treatment withdrawal increased over time (16.7% before 2008, 95.2% after 2017). Treatment withdrawal varied depending on the progestin derivative used (88.9% with cyproterone acetate, 84.6% with chlormadinone acetate, 28.6% with nomegestrol acetate, 66.7% with progestin derivative combination). The main reason for therapeutic management of meningiomas was the presence of clinical signs. Among the 54 meningiomas managed conservatively for which the progestin had been discontinued, MRI follow-up demonstrated a regression in 29.6%, a stability in 68.5%, and an ongoing growth in 1.9% of cases. CONCLUSIONS Conservative management, including progestin treatment discontinuation, has grown over time with promising results in terms of efficacy and safety.
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Affiliation(s)
- Henri Malaize
- Department of Neurosurgery, Service de Neurochirurgie, GHU site Sainte-Anne, Paris, France
- Université de Paris, Paris, France
| | - Thomas Samoyeau
- Université de Paris, Paris, France
- Department of Neuroradiology, GHU site Sainte-Anne, Paris, France
| | - Marc Zanello
- Department of Neurosurgery, Service de Neurochirurgie, GHU site Sainte-Anne, Paris, France
- Université de Paris, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR S1266, INSERM, IMA-BRAIN, Paris, France
| | - Alexandre Roux
- Department of Neurosurgery, Service de Neurochirurgie, GHU site Sainte-Anne, Paris, France
- Université de Paris, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR S1266, INSERM, IMA-BRAIN, Paris, France
| | - Joseph Benzakoun
- Université de Paris, Paris, France
- Department of Neuroradiology, GHU site Sainte-Anne, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR S1266, INSERM, IMA-BRAIN, Paris, France
| | - Sophie Peeters
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA
| | - Gilles Zah-Bi
- Department of Neurosurgery, Service de Neurochirurgie, GHU site Sainte-Anne, Paris, France
- Université de Paris, Paris, France
| | - Myriam Edjlali
- Université de Paris, Paris, France
- Department of Neuroradiology, GHU site Sainte-Anne, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR S1266, INSERM, IMA-BRAIN, Paris, France
| | | | - Edouard Dezamis
- Department of Neurosurgery, Service de Neurochirurgie, GHU site Sainte-Anne, Paris, France
- Université de Paris, Paris, France
| | - Eduardo Parraga
- Department of Neurosurgery, Service de Neurochirurgie, GHU site Sainte-Anne, Paris, France
- Université de Paris, Paris, France
| | - Fabrice Chrétien
- Université de Paris, Paris, France
- Department of Neuropathology, GHU site Sainte-Anne, Paris, France
| | - Pascale Varlet
- Université de Paris, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR S1266, INSERM, IMA-BRAIN, Paris, France
- Department of Neuropathology, GHU site Sainte-Anne, Paris, France
| | - Geneviève Plu-Bureau
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics, INSERM U1153, Paris-Descartes University, Paris, France
- Gynecology Endocrinology Unit, University Hospital Paris Centre, Cochin Hospital, APHP, Paris, France
| | - Catherine Oppenheim
- Université de Paris, Paris, France
- Department of Neuroradiology, GHU site Sainte-Anne, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR S1266, INSERM, IMA-BRAIN, Paris, France
| | - Johan Pallud
- Department of Neurosurgery, Service de Neurochirurgie, GHU site Sainte-Anne, Paris, France.
- Université de Paris, Paris, France.
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR S1266, INSERM, IMA-BRAIN, Paris, France.
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Roux A, Tauziede-Espariat A, Zanello M, Gareton A, Malaize H, Benzakoun J, Zah-Bi G, Oppenheim C, Plu-Bureau G, Chretien F, Pallud J. Symptomatic progestin-associated atypical grade II meningioma. A first case report. Neurochirurgie 2020; 66:174-178. [PMID: 32277999 DOI: 10.1016/j.neuchi.2019.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/24/2019] [Accepted: 12/08/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Long-term use of high-dose progestin is known to promote the development of meningioma. Atypical meningioma in a patient under progestin has not previously been reported. CASE REPORT A 53-year-old right-handed woman presented with focal onset seizures, without impaired consciousness. Medical history featured endometriosis, treated successively by cyproterone acetate 25mg/day for 2 months then 50mg/day for 101 months, and chlormadinone acetate 5mg/day for 68 months then 10mg/day for 83 months. Brain MRI revealed multiple extra-axial lesions suggestive of left central meningioma associated with anterior skull base meningiomatosis. Surgical resection of the left central meningioma was achieved and progestin was withdrawn. Neuropathology diagnosed grade II atypical meningioma. Close clinical and imaging monitoring was implemented without adjuvant oncological treatment. At 25 months, imaging follow-up showed no recurrence of the left central meningioma and a significant regression of all other lesions, except for the right frontal lesion. CONCLUSIONS Neurosurgeons should be aware of the possible aggressiveness of meningioma in patients under progestin, and particularly those treated by different types of progestin over a long period of time without interruption. This may require systematic close monitoring, to adapt neurosurgical management.
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Affiliation(s)
- A Roux
- Department of Neurosurgery, GHU de Paris, Sainte-Anne Hospital, 1, rue Cabanis, Paris, France; Paris Descartes University, Sorbonne Paris-Cité, Paris, France; INSERM, UMR 1266, IMA-Brain, Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - A Tauziede-Espariat
- Department of Neuropathology, GHU de Paris, Sainte-Anne Hospital, Paris, France
| | - M Zanello
- Department of Neurosurgery, GHU de Paris, Sainte-Anne Hospital, 1, rue Cabanis, Paris, France; Paris Descartes University, Sorbonne Paris-Cité, Paris, France; INSERM, UMR 1266, IMA-Brain, Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - A Gareton
- Paris Descartes University, Sorbonne Paris-Cité, Paris, France; Department of Neuropathology, GHU de Paris, Sainte-Anne Hospital, Paris, France
| | - H Malaize
- Department of Neurosurgery, GHU de Paris, Sainte-Anne Hospital, 1, rue Cabanis, Paris, France; Paris Descartes University, Sorbonne Paris-Cité, Paris, France; INSERM, UMR 1266, IMA-Brain, Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - J Benzakoun
- Paris Descartes University, Sorbonne Paris-Cité, Paris, France; INSERM, UMR 1266, IMA-Brain, Institute of Psychiatry and Neurosciences of Paris, Paris, France; Department of Neuropathology, GHU de Paris, Sainte-Anne Hospital, Paris, France
| | - G Zah-Bi
- Department of Neurosurgery, GHU de Paris, Sainte-Anne Hospital, 1, rue Cabanis, Paris, France; Paris Descartes University, Sorbonne Paris-Cité, Paris, France; INSERM, UMR 1266, IMA-Brain, Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - C Oppenheim
- Paris Descartes University, Sorbonne Paris-Cité, Paris, France; INSERM, UMR 1266, IMA-Brain, Institute of Psychiatry and Neurosciences of Paris, Paris, France; Department of Neuroradiology, GHU de Paris, Sainte-Anne Hospital, Paris, France
| | - G Plu-Bureau
- INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics, Paris-Descartes University, Paris, France; Gynecology Endocrinology Unit, University Hospital Paris Centre, Cochin Hospital, AP-HP, Paris, France
| | - F Chretien
- Paris Descartes University, Sorbonne Paris-Cité, Paris, France; INSERM, UMR 1266, IMA-Brain, Institute of Psychiatry and Neurosciences of Paris, Paris, France; Department of Neuropathology, GHU de Paris, Sainte-Anne Hospital, Paris, France
| | - J Pallud
- Department of Neurosurgery, GHU de Paris, Sainte-Anne Hospital, 1, rue Cabanis, Paris, France; Paris Descartes University, Sorbonne Paris-Cité, Paris, France; INSERM, UMR 1266, IMA-Brain, Institute of Psychiatry and Neurosciences of Paris, Paris, France.
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Broux E, Dewailly D, Catteau-Jonard S. [Spironolactone as a relay for cyproterone acetate in hyperandrogenic women]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2020; 48:181-186. [PMID: 31926311 DOI: 10.1016/j.gofs.2020.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Cyproterone acetate is actually the first-line anti-androgenic treatment for severe hyperandrogenism in women. However, as this treatment is currently controversial, the objective of the study was to evaluate the safety and efficacy of spironolactone as a relay for cyproterone acetate. METHODS This is a monocentric retrospective study conducted between December 2002 and January 2018 at the Jeanne de Flandre Hospital at the University Hospital Center of Lille. Patients with clinical hyperandrogenism who received treatment with cyproterone acetate and then spironolactone were included. A total of 37 patients were clinically and biologically evaluated before treatment, followed by cyproterone acetate and spironolactone. RESULTS Clinically, the vast majority of patients were satisfied with the relay by spironolactone and found no difference between the two treatments. Biologically, testosterone and delta-4 androstenedione levels were significantly decreased with cyproterone acetate and spironolactone compared to no treatment. No significant differences were found when comparing levels under cyproterone acetate and under spironolactone. In addition, 87,5% of patients were free of side effects. CONCLUSIONS The data collected show the clinical and biological efficacy of spironolactone as a relay for cyproterone acetate in the treatment of hyperandrogenism. This anti-androgen therefore appears as an effective and well-tolerated alternative, as a relay for cyproterone acetate in patients with hyperandrogenism.
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Affiliation(s)
- E Broux
- University Lille, CHU de Lille, service de gynécologie médicale, 59000 Lille, France; Service d'assistance médicale à la procréation, CH Calais, 1601, boulevard des Justes, 62100 Calais, France.
| | - D Dewailly
- University Lille, CHU de Lille, Inserm U1172, 59000 Lille, France.
| | - S Catteau-Jonard
- University Lille, CHU de Lille, service de gynécologie médicale, 59000 Lille, France; University Lille, CHU de Lille, Inserm U1172, 59000 Lille, France.
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Correspondance à propos de l’article : « Place de l’Androcur® dans le traitement de l’alopécie féminine diffuse ». Ann Dermatol Venereol 2019; 146:821-822. [DOI: 10.1016/j.annder.2019.09.601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 09/23/2019] [Accepted: 09/27/2019] [Indexed: 11/23/2022]
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