INTRODUCTION: @entity2903 ( @entity2904 ) is an oral alkylating agent that has been used over the past 8  years to treat aggressive @entity977 resistant to conventional therapy. To date, only 25 @entity1 treated with @entity2904 for ACTH producing @entity977 (14 @entity652 and 11 @entity189 ) have been reported. MATERIALS AND METHODS: We present  a retrospective review of the medical records of three @entity1 with aggressive ACTH producing @entity652 treated with @entity2904 . In the three cases there was evidence of progression to conventional therapy before starting @entity2904 . We used the conventional scheme for the treatment of @entity11 until completing 7, 12 and 6 cycles respectively. Reduction in @entity5 size was evident after the 3rd, 5th and 4th cycle of @entity2904 and progression free survival was 25, 19 and more than 12  months in the three @entity1 respectively. Improvement of the ocular and visual symptoms was evident after the 4th cycle of treatment in all cases. Normalization of urinary free @entity701 levels was achieved after the 3rd and 9th cycle in the two cases with @entity699 . Two of the three @entity1 received a second course of treatment when the disease progressed but it did not stop @entity5 progression. The principal side effects were G3 @entity1398 , G1 and G2 @entity882 , @entity2905 , @entity1395 and @entity390 . CONCLUSION: The treatment with @entity2904 is effective and safe in @entity1 with aggressive @entity5 resistant to conventional therapy. Nevertheless once the disease progresses, a second course of treatment does not seem to be effective.

@entity2903 for aggressive ACTH XXXX : failure of a second course of treatment.

@entity1 :: ('9606', 'Species') :: ['patients'] @entity390 :: ('MESH:D009325', 'Disease') :: ['nausea'] @entity882 :: ('MESH:D013921', 'Disease') :: ['thrombocytopenia'] @entity5 :: ('MESH:D009369', 'Disease') :: ['tumor', 'corticotrophin tumors'] @entity2904 :: ('CHEBI:72564', 'Chemical') :: ['TMZ'] @entity2905 :: ('MESH:D008231', 'Disease') :: ['G1 lymphopenia'] @entity189 :: ('MESH:D002277', 'Disease') :: ['carcinomas'] @entity699 :: ('MESH:D003480', 'Disease') :: ['hypercortisolism'] @entity1395 :: ('MESH:D001247', 'Disease') :: ['asthenia'] @entity11 :: ('MESH:D005910', 'Disease') :: ['gliomas'] @entity1398 :: ('MESH:D009503', 'Disease') :: ['neutropenia'] @entity977 :: ('MESH:D010911', 'Disease') :: ['pituitary tumors'] @entity701 :: ('MESH:D006854', 'Chemical') :: ['cortisol'] @entity2903 :: ('MESH:C047246', 'Chemical') :: ['Temozolomide'] @entity652 :: ('MESH:D000236', 'Disease') :: ['adenomas']
@entity977 :: (MESH:D010911,Disease) :: ['pituitary tumors']
