Table 3.

Drugs used in hormonal therapy of meningioma

Drug name	Drug composition/molecular formula administration			Mechanism of action	Type of study		References
Hormonal agents
Progesterone receptor-binding agents
Megestrol (Megace)		C22H30O3, orally administered	Progesterone receptor partial agonist			SSCT: no survival benefit shown		[108]
Mifepristone (RU- 486)		C29H35NO2 is a substituted 19-nor steroid compound and the first clinically available progesterone receptor antagonist; it is a derivative of the synthetic progestin norethindrone, orally given	It has antiprogesterone activity; it competes with progesterone for binding to its receptor, which leads to inhibition of the effects of endogenous or exogenous progesterone; progesterone receptor competitive antagonist			Mifepristone is useful in the treatment of vestibular schwannoma because of its anti-glucocorticoid effect; it also binds to progesterone receptors in meningiomas		[109]
Estrogen antagonists
Tamoxifen		C26H29NO is a tertiary amino compound and a stilbenoid, orally given	Estrogen receptor competent antagonist			A population-based study in Sweden found an association of tamoxifen with meningioma		[110]
Somatostatin
Octreotide (Sandostatin)		C49H66N10O10S2 is a synthetic long-acting cyclic octapeptide with anticancer properties, subcutaneous (s.c.) injection or intravenous (i.v.) infusion after dilution	It mimics somatostatin but is a more potent inhibitor of growth hormone, glucagon, and insulin; similar to somatostatin, this agent also suppresses the luteinizing hormone response to the gonadotropin-releasing hormone, decreases splanchnic blood flow, and inhibits the release of gastrin, serotonin, secretin, motilin, pancreatic polypeptide, and thyroid-stimulating hormone			Octreotide was administered with low toxicity in a small series of recurrent meningioma cases; somatostatin was found to decrease meningioma cell proliferation in vivo (Fig. 2)		[111]
Pasireotide (Signifor)		C58H66N10O9, subcutaneous injection	Somatostatin mimetic			Phase II study of monthly pasireotide LAR (SOM230C) for recurrent or progressive meningioma		[112]
GH receptor antagonists
Pegvisomant (somavert)		PEGylated form of mutant growth hormone, subcutaneously	PEGylated GH receptor antagonist			Pegvisomant was investigated in the treatment of acromegaly		[113]
IGF-I and IGF-II Antagonists
Fenretinide		C26H33NO2 is a synthetic retinoid, orally given	It shows inhibition of growth via apoptosis in various tumor cell lines			Studies were aimed at finding the role and mechanism of fenretinide in controlling the growth of cells in meningioma		[114]
Retinoids								[107]