Treatment Strategies for Dopamine Agonist-Resistant and Aggressive Prolactinomas: A Comprehensive Analysis of the...

Area of Science:

• Endocrinology
• Oncology
• Molecular Biology

Background:

• Prolactinomas are typically responsive to endocrine therapy and surgery.
• A subset of prolactinomas exhibit resistance to treatment and aggressive invasive growth.

Purpose of the Study:

• To define molecular and endocrinological characteristics of dopamine agonist-resistant and aggressive prolactinomas.
• To guide the development of novel multimodality treatment strategies.

Main Methods:

• Review of preclinical models, case studies, and small series evaluating various treatment modalities.
• Analysis of clinical, pathological, and molecular features of aggressive prolactinomas.
• Discussion of a unique case with rapidly increasing tumor proliferation (Ki67) and massive invasion.

Main Results:

• Multiple novel therapeutic agents are under investigation, including chemotherapy, targeted therapies, and hormonal modulators.
• Potential future therapeutic targets include chorionic gonadotropin, gonadotropin-releasing hormone, TGFβ, and PRDM2.
• A case demonstrated a significant increase in Ki67, massive invasion, and extremely high prolactin levels.

Conclusions:

• Understanding the molecular basis of aggressive prolactinomas is crucial for effective treatment.
• Multimodality approaches incorporating novel therapies are essential for managing resistant and invasive tumors.
• Further research into molecular targets may offer new avenues for aggressive prolactinoma management.