 Most, though not all Lamberts 1995; Koper 1992 in vitro studies suggest that the addition of somatostatin inhibits meningioma growth, and accelerates apoptosis, suggesting a potential therapeutic role for somatostatin receptor agonists Arena 2004. SOM230 pasireotide is a novel somatostatin analogue with affinity for multiple somatostatin receptors. Compared to octreotide Sandostatin, SOM230 binds to a wider spectrum of somatostatin receptors, including subtypes 1, 2, 3, and 5, and possesses as a higher binding affinity for subtypes 1, 3, and 5. In a recent study evaluating the expression of somatostatin receptor mRNA in human meningiomas Arena 2004, 88 of the tumors 3742 were positive for at least 1 of the 5 SSTR subtypes. SSTR1 and SSTR2 were most commonly detected in meningiomas 69 2942 and 79 3342 respectively. The other subtypes were also frequently detected 43, 33, and 33 for SSTR3, SSTR4, and SSTR5 respectively. In recently completed studies with SOM230 in patients with Cushings disease and acromegaly, clinical responses have been documented in patients who were refractory to Sandostatin. In summary, SOM230 has broader binding affinity to somatostatin receptors than Sandostatin, its toxicity is very modest, and qualitatively identical to that of Sandostatin, and its longer half-life approximately 23 hours allows a more convenient twice daily in contrast to three times a day dosing schedule compared with Sandostatin. For all these reasons, we anticipate that the efficacy and tolerability of SOM230 in patients with recurrent meningiomas should be better than that observed with Sandostatin. We therefore, propose a formal phase II trial of SOM230 pasireotide in patients with recurrent or progressive meningiomas who have already undergone or are not candidates for additional surgery or radiation. 