Aggressive prolactinomas: how to manage?
Aggressive prolactinomas: how to manage?
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DOI：
10.1007/s11102-019-01000-7
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发表时间：
2019-10-15
期刊：
影响因子：
3.8
通讯作者：
Raverot, Gerald
中科院分区：
文献类型：
--
作者：
Lasolle, Helene;Ilie, Mirela Diana;Raverot, Gerald
目的侵袭性泌乳素瘤是指放射学上浸润性肿瘤，不能通过手术治愈，尽管使用多巴胺受体激动剂治疗和手术，但肿瘤生长速度异常快。在某些情况下，转移发生，定义催乳素癌，这是第二个最常见的垂体癌。方法通过文献检索，对侵袭性垂体泌乳素瘤或垂体泌乳素癌的治疗进行回顾性分析。结果当最佳的标准治疗（高剂量卡麦角林，手术和放疗）失败时，替莫唑胺，一种烷化剂，是目前最好的选择，允许控制肿瘤生长在约50%的治疗泌乳素瘤，提高这些患者的总生存期。然而，长期完全缓解发生在有限的肿瘤亚组中。在替莫唑胺（帕瑞肽，肽受体放射性核素治疗水平省略号）或替莫唑胺失败后，可以讨论侵袭性泌乳素瘤的替代药物。结论：尽管使用替莫唑胺获得了显着改善，需要替代药物仍然存在，因为大多数这些肿瘤是耐药的或将在随访期间复发。患有这种罕见疾病的患者应该能够获得其他类型罕见癌症的临床试验，如酪氨酸激酶抑制剂或免疫疗法。
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 horizontal ellipsis ) 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.