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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas

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Published on: January 17, 2018

Targeting Aggressive Pituitary Adenomas at the Molecular Level-A Review.

Benjamin Voellger¹, Zhuo Zhang^1,2, Julia Benzel^1,3

¹Department of Neurosurgery, University Hospital Marburg, Baldingerstr., 35033 Marburg, Germany.

Journal of Clinical Medicine

|January 11, 2022

Summary

Aggressive pituitary adenomas (PAs) present treatment challenges. Targeting immune checkpoints (PD-1/PD-L1), growth factor pathways (EGFR, mTOR, VEGF, FGF), and invasion mechanisms (MMPs, ERs) offers new therapeutic avenues.

Keywords:

adjuvant treatment hormone secretion invasiveness molecular biology pituitary adenomas proliferation

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Area of Science:

Endocrinology
Oncology
Pharmacology

Background:

Pituitary adenomas (PAs) are typically benign endocrine tumors.
A subset of PAs (up to 10%) exhibit aggressive behavior, including invasion, rapid proliferation, and recurrence.
Current treatments for aggressive PAs are limited, necessitating novel therapeutic strategies.

Purpose of the Study:

To provide an overview of target structures in aggressive pituitary adenomas.
To summarize current clinical trials relevant to aggressive PAs.
To explore potential therapeutic strategies for aggressive PAs.

Main Methods:

Review of existing literature on drug targets and clinical trials for PAs.
Analysis of molecular pathways implicated in PA proliferation, migration, and angiogenesis.
Examination of targets related to tumor invasiveness.

Main Results:

Immune checkpoint inhibitors (e.g., PD-1/PD-L1) show potential for aggressive PAs.
Growth factor pathways (EGFR, mTOR, VEGF, FGF) are key targets for modulating proliferation and angiogenesis.
Temozolomide (TMZ), alone or in combination, demonstrates efficacy. Dopamine agonists (DAs) may treat various PA subtypes.
Targets for invasiveness include matrix metalloproteinases (MMPs) and estrogen receptors (ERs).

Conclusions:

Multiple therapeutic targets and strategies exist for aggressive PAs.
Targeting immune checkpoints, growth factor pathways, and invasive mechanisms offers promising treatment options.
Combination therapies and repurposed drugs like DAs hold potential for improved outcomes in aggressive PAs.