Clinical, Immunological And Molecular-Genetic Characteristic Of Aggressive Pituitary Adenomas

The use of tyrosine kinase inhibitors (lapatinib, sunitib, erlotinib) is being considered, and only one case reported a partial response to lapatanib with lactotropic APA [8]. VEGF-targeted therapy with bevacizumab alone or in combination with Tamazolamide (Interleukin-6 imhibitor) has occasionally resulted in partial response or stable disease, although progressive disease has also been reported [31].

Finally, there is interest in the potential use of immunotherapy for the treatment of APA. Pituitary neoplasms, especially APA, have been shown to express programmed death ligand 1 (PD-L1), a T cell immune checkpoint biomarker, along with tumor infiltrating lymphocytes [61].

CONCLUSIONS

Aggressive pituitary adenomas are a separate group of tumors that need to be evaluated, taking into account all clinical features, as well as histopathological, molecular genetic, and radiological characteristic. Morphological and molecular genetics analyses should predict the aggressive behavior of APA, which is currently a problem all over the world. The study of specific markers of aggressiveness is crucial in the management of patients, prevention of recurrence and progression of adenomas. Moreover, the pathophysiology and diagnosis of aggressive pituitary adenomas should focus on the new studies directed to the potential treatment involved the target specific pathways. Cellular signaling pathway is the main reason of the proliferation and angiogenesis of pituitary adenomas and in the combination with new conventional therapies, it may open up new opportunities for the treatment of AAG.

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