Refractory pituitary adenomas (PAs) are defined as aggressive-invasive PAs characterized by a high Ki-67 index, rapid growth, frequent recurrence, and resistance to conventional treatments. Refractory PAs are notoriously difficult to manage due to the efficacy of current therapeutic options. Apart from for prolactinomas, neurosurgery is the first-line option, but most refractory PAs often recur or re-grow after initial surgery and require further treatments. Medical therapy, radiotherapy and re-operation are considered when surgery has failed to completely resect tumors; however, refractory PAs are usually resistant to these treatments. As a salvage treatment, temozolomide (TMZ) has shown promising results and is currently used for all types of refractory PAs. However, not all refractory PAs are responsive to TMZ treatment, and some of these PAs are resistant to TMZ. Although targeted therapies such as vascular endothelial growth factor, epidermal growth factor and mTOR inhibitors have also been used to treat refractory PAs, the effectiveness of these targeted therapies is still not known due to a lack of data from randomized prospective trials. As a novel therapeutic method, cancer immunotherapy is a promising strategy for the treatment of refractory PAs, but further preclinical research and clinical trials are needed to assess the efficacy of this new approach.
Within this Research Topic on the “Refractory Pituitary Adenoma—Current Challenges and Emerging Treatments” hosted by the Pituitary Endocrinology Section of Frontiers in Endocrinology, an overview on the recent progress in the current difficulties in diagnosis and treatment of refractory PAs, pre-clinical research and the translation of these findings into clinical practice will be presented. To this end, experts of different areas of pre-clinical and clinical research on Pituitary Endocrinology are welcomed to submit Original Research as well as Review articles on current developments on Refractory PAs.
Those developments include, but are not limited to:
1) Difficulties encountered during surgery, such as:
Surgical treatment of invasive pituitary adenoma, Surgical Management in Patients with Cushing Disease with Negative Pituitary Magnetic Resonance Imaging, Surgical Management of recurrent Cushing’s disease, the problems of postoperative recurrence, Significance of pseudocapsule in the excision of pituitary adenomas in transsphenoidal surgery.
2) Different types of radiotherapy of pituitary adenoma, including indications for different types of radiotherapy, side effects and recurrence after radiotherapy.
3) Medical therapy and clinical trails of pituitary adenomas, including the medical treatment of Cushing's Disease, temozolomide treatment, targeted therapy, and immunotherapy.
4) Radiomics in the pituitary adenomas including the association of Radiomics and clinical features and pathological features of pituitary adenoma.
5) The progress of immunotherapy in the refractory PAs.
6) The basic research about pituitary adenomas including Pathogenesis of pituitary adenomas, new pathological classification of pituitary adenoma, Temozolomide treatment of pituitary adenomas, resistance mechanism of Temozolomide treatment in the pituitary adenomas, the mechanism of resistance mechanism of dopamine agonists in PRL-omas.
Refractory pituitary adenomas (PAs) are defined as aggressive-invasive PAs characterized by a high Ki-67 index, rapid growth, frequent recurrence, and resistance to conventional treatments. Refractory PAs are notoriously difficult to manage due to the efficacy of current therapeutic options. Apart from for prolactinomas, neurosurgery is the first-line option, but most refractory PAs often recur or re-grow after initial surgery and require further treatments. Medical therapy, radiotherapy and re-operation are considered when surgery has failed to completely resect tumors; however, refractory PAs are usually resistant to these treatments. As a salvage treatment, temozolomide (TMZ) has shown promising results and is currently used for all types of refractory PAs. However, not all refractory PAs are responsive to TMZ treatment, and some of these PAs are resistant to TMZ. Although targeted therapies such as vascular endothelial growth factor, epidermal growth factor and mTOR inhibitors have also been used to treat refractory PAs, the effectiveness of these targeted therapies is still not known due to a lack of data from randomized prospective trials. As a novel therapeutic method, cancer immunotherapy is a promising strategy for the treatment of refractory PAs, but further preclinical research and clinical trials are needed to assess the efficacy of this new approach.
Within this Research Topic on the “Refractory Pituitary Adenoma—Current Challenges and Emerging Treatments” hosted by the Pituitary Endocrinology Section of Frontiers in Endocrinology, an overview on the recent progress in the current difficulties in diagnosis and treatment of refractory PAs, pre-clinical research and the translation of these findings into clinical practice will be presented. To this end, experts of different areas of pre-clinical and clinical research on Pituitary Endocrinology are welcomed to submit Original Research as well as Review articles on current developments on Refractory PAs.
Those developments include, but are not limited to:
1) Difficulties encountered during surgery, such as:
Surgical treatment of invasive pituitary adenoma, Surgical Management in Patients with Cushing Disease with Negative Pituitary Magnetic Resonance Imaging, Surgical Management of recurrent Cushing’s disease, the problems of postoperative recurrence, Significance of pseudocapsule in the excision of pituitary adenomas in transsphenoidal surgery.
2) Different types of radiotherapy of pituitary adenoma, including indications for different types of radiotherapy, side effects and recurrence after radiotherapy.
3) Medical therapy and clinical trails of pituitary adenomas, including the medical treatment of Cushing's Disease, temozolomide treatment, targeted therapy, and immunotherapy.
4) Radiomics in the pituitary adenomas including the association of Radiomics and clinical features and pathological features of pituitary adenoma.
5) The progress of immunotherapy in the refractory PAs.
6) The basic research about pituitary adenomas including Pathogenesis of pituitary adenomas, new pathological classification of pituitary adenoma, Temozolomide treatment of pituitary adenomas, resistance mechanism of Temozolomide treatment in the pituitary adenomas, the mechanism of resistance mechanism of dopamine agonists in PRL-omas.