European Society of Endocrinology Clinical Practice Guidelines for the management of aggressive pituitary tumours and carcinomas
Top Cited Papers
- 1 January 2018
- journal article
- research article
- Published by Oxford University Press (OUP) in Acta Endocrinologica
- Vol. 178 (1), G1-G24
- https://doi.org/10.1530/EJE-17-0796
Abstract
Background: Pituitary tumours are common and easily treated by surgery or medical treatment in most cases. However, a small subset of pituitary tumours does not respond to standard medical treatment and presents with multiple local recurrences (aggressive pituitary tumours) and in rare occasion with metastases (pituitary carcinoma). The present European Society of Endocrinology (ESE) guideline aims to provide clinical guidance on diagnosis, treatment and follow-up in aggressive pituitary tumours and carcinomas. Methods: We decided upfront, while acknowledging that literature on aggressive pituitary tumours and carcinomas is scarce, to systematically review the literature according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. The review focused primarily on first-and second-line treatment in aggressive pituitary tumours and carcinomas. We included 14 single-arm cohort studies (total number of patients = 116) most on temozolomide treatment (n = 11 studies, total number of patients = 106). A positive treatment effect was seen in 47% (95% CI: 36-58%) of temozolomide treated. Data from the recently performed ESE survey on aggressive pituitary tumours and carcinomas (165 patients) were also used as backbone for the guideline. Selected recommendation: (i) Patients with aggressive pituitary tumours should be managed by a multidisciplinary expert team. (ii) Histopathological analyses including pituitary hormones and proliferative markers are needed for correct tumour classification. (iii) Temozolomide monotherapy is the first-line chemotherapy for aggressive pituitary tumours and pituitary carcinomas after failure of standard therapies; treatment evaluation after 3 cycles allows identification of responder and non-responder patients. (iv) In patients responding to first-line temozolomide, we suggest continuing treatment for at least 6 months in total. Furthermore, the guideline offers recommendations for patients who recurred after temozolomide treatment, for those who did not respond to temozolomide and for patients with systemic metastasis.This publication has 175 references indexed in Scilit:
- Peptide receptor radionuclide therapy in a patient with disabling non-functioning pituitary adenomaPituitary, 2013
- 2013 European Thyroid Association Guidelines for the Diagnosis and Treatment of Thyrotropin-Secreting Pituitary TumorsEuropean Thyroid Journal, 2013
- Temozolomide in the management of dopamine agonist–resistant prolactinomasClinical Endocrinology, 2012
- EGFR as a therapeutic target for human, canine, and mouse ACTH-secreting pituitary adenomasJCI Insight, 2011
- Aggressive pituitary tumours: the role of temozolomide and the assessment of MGMT statusEuropean Journal of Clinical Investigation, 2011
- Somatostatin Receptor-Targeted Radionuclide Therapy in Patients with Gastroenteropancreatic Neuroendocrine TumorsEndocrinology and Metabolism Clinics of North America, 2011
- HER2/ErbB2 Receptor Signaling in Rat and Human Prolactinoma Cells: Strategy for Targeted Prolactinoma TherapyMolecular Endocrinology, 2011
- Radiosensitizing Effects of Temozolomide Observed in vivo only in a Subset of O6-Methylguanine-DNA Methyltransferase Methylated Glioblastoma Multiforme XenograftsInternational Journal of Radiation Oncology*Biology*Physics, 2009
- Rat Prolactinoma Cell Growth Regulation by Epidermal Growth Factor Receptor LigandsCancer Research, 2008
- A prospective, multicentre study to investigate the efficacy, safety and tolerability of octreotide LAR® (long‐acting repeatable octreotide) in the primary therapy of patients with acromegalyClinical Endocrinology, 2007