Treatment of Aggressive Pituitary Adenomas: A Case-Based Narrative Review

Management of aggressive pituitary adenomas is challenging due to a paucity of rigorous evidence supporting available treatment approaches. Recent guidelines emphasize the need to maximize standard therapies as well as the use of temozolomide and radiation therapy to treat disease recurrence. Howeve...

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Published inFrontiers in endocrinology (Lausanne) Vol. 12; p. 725014
Main Authors Cooper, Odelia, Bonert, Vivien, Liu, Ning-Ai, Mamelak, Adam N
Format Journal Article
LanguageEnglish
Published Switzerland Frontiers Media S.A 15.11.2021
Subjects
Adenoma - pathology
Adenoma - therapy
Adolescent
Adult
aggressive adenomas
Child
Combined Modality Therapy
Endocrinology
Female
Humans
Male
pituitary adenomas
Pituitary Neoplasms - pathology
Pituitary Neoplasms - therapy
Prognosis
radiation therapy
surgery
targeted therapy
temozolomide
Young Adult
aggressive adenomas
temozolomide
targeted therapy
pituitary adenomas
radiation therapy
surgery
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Summary:Management of aggressive pituitary adenomas is challenging due to a paucity of rigorous evidence supporting available treatment approaches. Recent guidelines emphasize the need to maximize standard therapies as well as the use of temozolomide and radiation therapy to treat disease recurrence. However, often these adenomas continue to progress over time, necessitating the use of additional targeted therapies which also impact quality of life and long-term outcomes. In this review, we present 9 cases of aggressive pituitary adenomas to illustrate the importance of a multidisciplinary, individualized approach. The timing and rationale for surgery, radiation therapy, temozolomide, somatostatin receptor ligands, and EGFR, VEGF, and mTOR inhibitors in each case are discussed within the context of evidence-based guidelines and clarify strategies for implementing an individualized approach in the management of these difficult-to-treat-adenomas.
Bibliography:ObjectType-Case Study-3
SourceType-Scholarly Journals-1
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ObjectType-Review-1
ObjectType-Feature-5
ObjectType-Report-2
ObjectType-Article-4
Reviewed by: Greisa Vila, Medical University of Vienna, Austria; Jacqueline Trouillas, Université Claude Bernard Lyon 1, France
This article was submitted to Pituitary Endocrinology, a section of the journal Frontiers in Endocrinology
Edited by: Monica Livia Gheorghiu, Carol Davila University of Medicine and Pharmacy, Romania
ISSN:1664-2392
1664-2392
DOI:10.3389/fendo.2021.725014