Current Treatment Strategies in Managing Aggressive Pituitary Tumors

Michael Buchfelder pulls together recent studies with a good synopsis of current treatments for aggressive pituitary tumors in this article. However, he doesn't address ACTH-producing adenomas which cause Cushing's Disease. He does, however, talk about some of the treatments that are being used for other types of tumors.

Buchfelder discusses the use of dopamine agents to control prolactinomas, and focuses on cabergoline and bromocriptine. Cabergoline is the preferred agent due to its ability to normalize prolactin levels as well as shrink tumor size with few side effects.

In the article, surgery is always the front-line approach for other tumors with secondary treatments to control recurrence and/or regrowth. Transsphenoidal endoscopic surgery is the first-line approach, but he does say surgical techniques can remove the bulk of the tumor "but do nothing to reduce the recurrence of aggressive tumors."

The somatostatin analogs (SSAs) lanreotide and octreotide are mentioned as effective agents for "other kinds of tumors", but only treatment of those causing acromegaly are described in depth.

SSAs can be used as primary therapy, pre-operatively to reduce the tumor volume
and make it more amenable to surgical removal, or post-surgery to control
re-expansion.

He also mentions the recent studies using the chemotherapy agent, temozolomide (another research blog I did recently), to control aggressive pituitary tumors.

Radiotherapy is a non-pharmacological treatment outlined in the article, with stereotactic radiation is only working for small tumors with the "precise location" known. Any type of radiotherapy works best in conjunction with surgical intervention.

He really articulates well the frustrations and complications with treating pituitary tumors with his closing remarks:

...we should not be reticent about using all options available (even in a single patient if necessary) to get the best possible control of symptoms.

Michael Buchfelder (2008). Management of aggressive pituitary adenomas: current treatment strategies Pituitary DOI: 10.1007/s11102-008-0153-z

There is more research on future treatment strategies which I hope to share in the next few days.

To learn more:

Is Temozolomide a new treatment for aggressive pituitary tumors?

A novel pituitary tumor transforming gene identified

A Cushie Champion: Dr. Ian McCutcheon (MD Anderson) (talks about tumors and treatments)

Recent Advances in Neuroendocrine Imaging Lead to Improved Diagnosis