Webb Lauren M, Okuno Scott H, Ransom Ryan C, Van Gompel Jamie J, Humes Allison L, Sarkaria Jann N, Ruff Michael W
Department of Neurology, Mayo Clinic, Rochester, Minnesota.
Department of Oncology, Mayo Clinic, Rochester, Minnesota.
J Neurosurg Case Lessons. 2025 Jan 13;9(2). doi: 10.3171/CASE24410.
Adamantinomatous craniopharyngiomas (ACPs) are slow-growing, cystic, highly morbid central nervous system tumors located adjacent to vital structures including the pituitary, hypothalamus, and optic chiasm. Tumor recurrence is common. Treatment relies on resection with or without adjuvant radiation and is highly individualized. Targeted chemotherapies have not been routinely used in the treatment of ACPs.
The authors present the case of an adult patient with recurrent ACP that was clinically and radiologically stabilized with a combination of bevacizumab and tocilizumab every 3 weeks.
The combination of tocilizumab and bevacizumab could be an effective therapy for shrinkage of the cystic and solid components of ACP, sparing patients from further neurological damage from the tumor, additional surgery, or radiation. The patient's positive response to tocilizumab and bevacizumab supports the growing literature that interleukin-6 and vascular endothelial growth factor are important for ACP pathogenesis. The patient's response supports prior research, suggesting that systemic chemotherapy can be effectively delivered to this rare brain tumor. https://thejns.org/doi/10.3171/CASE24410.
造釉细胞瘤型颅咽管瘤（ACPs）是生长缓慢的囊性中枢神经系统肿瘤，位于包括垂体、下丘脑和视交叉在内的重要结构附近。肿瘤复发很常见。治疗依赖于手术切除，可联合或不联合辅助放疗，且高度个体化。靶向化疗尚未常规用于ACPs的治疗。
作者报告了一例复发性ACPs成年患者的病例，该患者每3周接受贝伐单抗和托珠单抗联合治疗，临床和影像学表现均稳定。
托珠单抗和贝伐单抗联合使用可能是一种有效的治疗方法，可缩小ACPs的囊性和实性成分，使患者免受肿瘤、额外手术或放疗造成的进一步神经损伤。患者对托珠单抗和贝伐单抗的阳性反应支持了越来越多的文献观点，即白细胞介素-6和血管内皮生长因子对ACPs的发病机制很重要。患者的反应支持了先前的研究，表明全身化疗可有效应用于这种罕见的脑肿瘤。https://thejns.org/doi/10.3171/CASE24410
