Aggressive pituitary tumours and pituitary carcinomas.
Journal
Nature reviews. Endocrinology
ISSN: 1759-5037
Titre abrégé: Nat Rev Endocrinol
Pays: England
ID NLM: 101500078
Informations de publication
Date de publication:
11 2021
11 2021
Historique:
accepted:
23
07
2021
pubmed:
9
9
2021
medline:
29
12
2021
entrez:
8
9
2021
Statut:
ppublish
Résumé
Although usually benign, anterior pituitary tumours occasionally exhibit aggressive behaviour, with invasion of surrounding tissues, rapid growth, resistance to conventional treatments and multiple recurrences. In very rare cases, they metastasize and are termed pituitary carcinomas. The time between a 'classical' pituitary tumour and a pituitary carcinoma can be years, which means that monitoring should be performed regularly in patients with clinical (invasion and/or tumour growth) or pathological (Ki67 index, mitotic count and/or p53 detection) markers suggesting aggressiveness. However, although both invasion and proliferation have prognostic value, such parameters cannot predict outcome or malignancy without metastasis. Future research should focus on the biology of both tumour cells and their microenvironment, hopefully with improved therapeutic outcomes. Currently, the initial therapeutic approach for aggressive pituitary tumours is generally to repeat surgery or radiotherapy in expert centres. Standard medical treatments usually have no effect on tumour progression but they can be maintained on a long-term basis to, at least partly, control hypersecretion. In cases where standard treatments prove ineffective, temozolomide, the sole formally recommended treatment, is effective in only one-third of patients. Personalized use of emerging therapies, including peptide receptor radionuclide therapy, angiogenesis-targeted therapy and immunotherapy, will hopefully improve the outcomes of patients with this severe condition.
Identifiants
pubmed: 34493834
doi: 10.1038/s41574-021-00550-w
pii: 10.1038/s41574-021-00550-w
doi:
Substances chimiques
Temozolomide
YF1K15M17Y
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
671-684Informations de copyright
© 2021. Springer Nature Limited.
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