Aggressive prolactinomas: how to manage?

Area of Science:

• Endocrinology
• Neuro-oncology
• Oncology

Background:

• Aggressive prolactinomas are invasive pituitary tumors resistant to standard treatments.
• Prolactin carcinomas, a form of pituitary carcinoma, can metastasize.

Purpose of the Study:

• To review current treatment strategies for aggressive pituitary prolactinomas and carcinomas.
• To identify effective therapies beyond standard dopamine agonist treatment, surgery, and radiotherapy.

Main Methods:

• Literature search on the treatment of aggressive prolactinomas and carcinomas.
• Review of data on efficacy and outcomes of various therapeutic interventions.

Main Results:

• Temozolomide is the current best option for aggressive prolactinomas, controlling tumor growth in approximately 50% of patients.
• Long-term complete response to temozolomide is limited; alternative drugs like pasireotide or peptide receptor radionuclide therapy may be considered.
• Temozolomide improves overall survival but does not guarantee a cure for all patients.

Conclusions:

• Despite temozolomide's benefits, a significant proportion of aggressive prolactinomas remain resistant or recur.
• There is a persistent need for novel therapeutic agents to manage these rare and aggressive pituitary tumors.
• Access to clinical trials for rare cancers, including tyrosine kinase inhibitors and immunotherapy, is crucial for patients with aggressive prolactinomas.