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Review
. 2023 Aug;26(4):474-481.
doi: 10.1007/s11102-023-01340-5. Epub 2023 Jul 10.

The treatment of aggressive prolactinomas with everolimus

Andrew L Lin  1   2   3   4 , Eliza B Geer  5   6   7 , Nupur Lala  8 , Gabrielle Page-Wilson  9 , Rajiv Magge  10 , Robert J Young  11 , Viviane Tabar  5   6
Affiliations
Review

The treatment of aggressive prolactinomas with everolimus

Andrew L Lin et al. Pituitary. 2023 Aug.

Abstract

Introduction: Aggressive prolactinomas are life-limiting tumors without a standard of care treatment option after the oral alkylator, temozolomide, fails to provide tumor control.

Methods: We reviewed an institutional database of pituitary tumors for patients with aggressive prolactinomas who progressed following treatment with a dopamine receptor agonist, radiotherapy and temozolomide. Within this cohort, we identified four patients who were treated with everolimus and we report their response to this therapy. Treatment response was determined by a neuroradiologist, who manually performed volumetric assessment and determined treatment response by Response Assessments in Neuro-Oncology (RANO) criteria.

Results: Three of four patients who were treated with everolimus had a biochemical response to therapy and all patients derived a clinically meaningful benefit based upon suppression of tumor growth. While the best overall response as assessed by RANO criteria was stable disease for the four patients, a minor regression in tumor size was appreciated in two of the four patients.

Conclusion: Everolimus is an active agent in the treatment of prolactinomas that warrants further investigation.

Keywords: Aggressive pituitary adenoma; Pituitary carcinoma; Prolactinoma; Targeted therapy.

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Figures

Fig. 1:
Fig. 1:
Treatment response to everolimus in patient 1. Panel A shows a diagram plot of tumor volume (cm3) and tumor size (cm2) per RANO criteria in relationship to time on everolimus therapy. Panel B shows prolactin levels over the course of treatment.
Fig. 2
Fig. 2
Treatment response to everolimus. Panel A shows serial axial contrast-enhanced T1-weighted images of a radiation naïve leptomeningeal nodule. Panel B shows a diagram plot of prolactin levels over the course of treatment.
Fig. 3:
Fig. 3:
Treatment response to everolimus in patient 3. Panel A shows a diagram plot of tumor volume (cm3) and tumor size (cm2) per RANO criteria in relationship to time on everolimus therapy. Panel B shows prolactin levels over the course of treatment.
Fig. 4:
Fig. 4:
Treatment response to everolimus in patient 4. Panel A shows a diagram plot of tumor volume (cm3) and tumor size (cm2) per RANO criteria in relationship to time on everolimus therapy. Panel B shows prolactin levels over the course of treatment.
See this image and copyright information in PMC

References

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