Endocrinology Department, "C. I. Parhon" National Institute of Endocrinology, Bucharest, Bucharest-Ilfov, Romania.
Endocrinology Department, Reference Center for Rare Pituitary Diseases HYPO, "Groupement Hospitalier Est" Hospices Civils de Lyon, Bron, Auvergne-Rhône-Alpes, France.
J Clin Endocrinol Metab. 2020 Oct 1;105(10). doi: 10.1210/clinem/dgaa497.
Gonadotroph tumors represent approximatively one-third of anterior pituitary tumors, but despite their frequency, no medical treatment is currently recommended for them. This would be greatly needed because following surgery, which is the first-line treatment, a significant percentage of gonadotroph tumors regrow.
We performed PubMed searches in March 2020 using the term "gonadotroph" in combination with 36 different keywords related to dopamine type 2 receptor agonists, somatostatin receptor (SST) ligands, temozolomide, peptide receptor radionuclide therapy (PRRT), immunotherapy, vascular endothelial growth factor receptor (VEGFR)-targeted therapy, mammalian target of rapamycin (mTOR) inhibitors, and tyrosine kinase inhibitors. Articles resulting from these searches, as well as relevant references cited by these articles were reviewed.
SST2 analogs have demonstrated only very limited antitumor effect, while high-dose cabergoline has been more effective in preventing tumor regrowth, but still in only a minority of cases. In the setting of an aggressive gonadotroph tumor, temozolomide is the recommended medical treatment, but has demonstrated also only limited efficacy. Still, its efficacy has been so far better than that of PRRT. No case of a gonadotroph tumor treated with pasireotide, VEGFR-targeted therapy, mTOR inhibitors, tyrosine kinase inhibitors, or immune checkpoint inhibitors is reported in literature.
Gonadotroph tumors need better phenotyping in terms of both tumor cells and associated tumor microenvironment to improve their treatment. Until formal recommendations will be available, we provide the readers with our suggested approach for the management of gonadotroph tumors, management that should be discussed within multidisciplinary teams.
促性腺激素肿瘤约占垂体前叶肿瘤的三分之一，但尽管它们很常见，目前仍没有推荐的治疗方法。这是非常必要的，因为在手术（一线治疗）后，很大一部分促性腺激素肿瘤会复发。
我们于 2020 年 3 月在 PubMed 上进行了检索，使用术语“促性腺激素”与 36 个不同的关键词相结合，这些关键词与多巴胺 2 型受体激动剂、生长抑素受体（SST）配体、替莫唑胺、肽受体放射性核素治疗（PRRT）、免疫疗法、血管内皮生长因子受体（VEGFR）靶向治疗、哺乳动物雷帕霉素靶蛋白（mTOR）抑制剂和酪氨酸激酶抑制剂有关。对这些搜索结果以及这些文章引用的相关参考文献进行了回顾。
SST2 类似物仅显示出非常有限的抗肿瘤作用，而高剂量卡麦角林在预防肿瘤复发方面更有效，但仍仅在少数情况下有效。在侵袭性促性腺激素肿瘤的情况下，替莫唑胺是推荐的治疗方法，但也仅显示出有限的疗效。尽管如此，其疗效迄今为止优于 PRRT。文献中没有报道过使用培高利特、VEGFR 靶向治疗、mTOR 抑制剂、酪氨酸激酶抑制剂或免疫检查点抑制剂治疗促性腺激素肿瘤的病例。
促性腺激素肿瘤需要更好地对肿瘤细胞及其相关肿瘤微环境进行表型分析，以改善其治疗效果。在正式建议出台之前，我们为读者提供了我们建议的促性腺激素肿瘤管理方法，该方法应在多学科团队中进行讨论。
