[Immunotherapy in the treatment of aggressive pituitary tumors and carcinomas]

Since the therapeutic failure of temozolomide (TMZ), the first-line chemotherapy recommended against aggressive pituitary tumors (APTs) and pituitary carcinomas (PCs), there have been no solid evidence-based treatment recommendations. However, immune checkpoint inhibitors (ICIs) have emerged as a promising and recent therapeutic option, generating hope after the first successful case was published in 2018. APTs and PCs are rare tumors with poor prognosis due to their invasive behavior and high recurrence rate despite conventional treatments. These neoplasms pose a therapeutic challenge in endocrinology as they can cause severe complications resulting from both tumor growth and hormonal secretion. In this context, and with a deeper understanding of the tumor microenvironment (TME) of pituitary adenomas (PAs), ICIs have emerged as an innovative therapeutic strategy. These agents reactivate the immune response against tumor cells and have shown promising results in various types of cancer. Although their application in pituitary tumors is still emerging, they offer new therapeutic perspectives that justify further investigation. This study aims to review and analyze the role of immunotherapy in the treatment of APTs and PCs. It seeks to evaluate the efficacy, mechanisms of action, available clinical evidence, and current challenges of this therapeutic approach. Additionally, it aims to identify factors that could predict a better response to immunotherapy in these patients.