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Aggressive prolactinomas: how to manage?

Abstract

Purpose

Aggressive prolactinomas are defined as radiologically invasive tumors which cannot be cured by surgery, and that have an unusually rapid rate of tumor growth despite dopamine agonist treatment and surgery. In some cases, metastasis occurs, defining prolactin carcinoma which is the second most frequent pituitary carcinoma.

Methods

A literature search was performed to review the available data on the treatment of aggressive pituitary prolactinomas or carcinomas.

Results

When optimal standard therapies (high dose cabergoline, surgery and radiotherapy) failed, temozolomide, an alkylating drug, is currently the best option, allowing to control tumor growth in about 50% of treated prolactinomas and improving overall survival of these patients. However, long-term complete response occurs in a limited subgroup of tumors. Alternative drugs could be discussed in a subset of aggressive prolactinomas either before temozolomide (pasireotide, peptide receptor radionuclide therapy…) or after temozolomide failure.

Conclusion

Despite the significant improvement obtained with the use of temozolomide, a need for alternative drugs persists since a majority of these tumors are resistant or will recur during the follow-up. Patients suffering from such a rare condition should have access to clinical trials available for other types of rare cancers, such as tyrosine kinase inhibitors or immunotherapy.

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Correspondence to Gérald Raverot.

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Conflict of interest

Gérald Raverot has received research Grants from Novartis Pharma and IPSEN; speaker honorarium from Novartis Pharma and IPSEN, consultant for Pfizer, Ipsen and Novartis. Mirela Diana Ilie and Hélène Lasolle declare they have no conflict of interest.

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Lasolle, H., Ilie, M.D. & Raverot, G. Aggressive prolactinomas: how to manage?. Pituitary 23, 70–77 (2020). https://doi.org/10.1007/s11102-019-01000-7

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Keywords

  • Pituitary tumor
  • Prolactinoma
  • Temozolomide
  • Pasireotide
  • Aggressive pituitary tumor
  • Pituitary carcinoma