Cardoso Ana Beatriz Ribeiro, Zimmermann Amanda Cristina, Raverot Gerald, Nunes-Nogueira Vania Dos Santos
Department of Internal Medicine, São Paulo State University (UNESP), Medical School, Botucatu, São Paulo, Brazil.
Endocrinology Department, Reference Center for Rare Pituitary Diseases HYPO, 'Groupement Hospitalier Est' Hospices Civils de Lyon, Bron, France.
Pituitary. 2025 Jun 2;28(3):70. doi: 10.1007/s11102-025-01541-0.
This systematic review aims to evaluate tumor control outcomes associated with antineoplastic drug therapies used for aggressive pituitary tumors (APTs) and pituitary carcinomas (PCs).
We included studies on patients with PC or APT who received one of the following therapies: temozolomide (TMZ), peptide receptor radionuclide therapy (PRRT), everolimus, immune checkpoint inhibitors (ICIs), lapatinib, bevacizumab, capecitabine plus temozolomide (CAPTEM). Search strategies were applied to MEDLINE, EMBASE, LILACS and CENTRAL. Two independent reviewers selected studies, assessed the risk of bias, and extracted data. Proportional meta-analyses were used to calculate overall frequencies of complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD).
Seventy eight studies were included. TMZ was the most commonly used therapy, followed by ICIs, bevacizumab, PRRT, CAPTEM, lapatinib, and everolimus. Among 434 patients treated with TMZ in studies involving three or more participants, CR occurred in 4% (95% confidence interval [95% CI], 1-13), PR in 33% (95% CI, 28-37), SD in 32% (95% CI, 28-36), and PD in 29% (95% CI, 25-34). For ICIs, PR occurred in 24% (95% CI, 11-44), SD in 12% (95% CI, 4-31), and PD in 67% (95% CI, 24-93).
TMZ was the most frequently reported therapy, with PR as the predominant outcome. However, the limited data on ICIs, PRRT, bevacizumab, lapatinib, and everolimus yielded imprecise results, highlighting the need for further research with the aim of gaining more insights into treatment effects of antineoplastic drug therapies for APTs and PCs.
本系统评价旨在评估用于侵袭性垂体瘤（APTs）和垂体癌（PCs）的抗肿瘤药物治疗相关的肿瘤控制结果。
我们纳入了接受以下治疗之一的PC或APT患者的研究：替莫唑胺（TMZ）、肽受体放射性核素治疗（PRRT）、依维莫司、免疫检查点抑制剂（ICIs）、拉帕替尼、贝伐单抗、卡培他滨加替莫唑胺（CAPTEM）。检索策略应用于MEDLINE、EMBASE、LILACS和CENTRAL。两名独立的评审员选择研究、评估偏倚风险并提取数据。采用比例荟萃分析计算完全缓解（CR）、部分缓解（PR）、疾病稳定（SD）和疾病进展（PD）的总体频率。
纳入78项研究。TMZ是最常用的治疗方法，其次是ICIs、贝伐单抗、PRRT、CAPTEM、拉帕替尼和依维莫司。在涉及三名或更多参与者的研究中，434例接受TMZ治疗的患者中，CR发生率为4%（95%置信区间[95%CI]，1-13），PR为33%（95%CI，28-37），SD为32%（95%CI，28-36），PD为29%（95%CI，25-34）。对于ICIs，PR发生率为24%（95%CI，11-44），SD为12%（95%CI，4-31），PD为67%（95%CI，24-93）。
TMZ是报告最频繁的治疗方法，PR是主要结果。然而，关于ICIs、PRRT、贝伐单抗、拉帕替尼和依维莫司的数据有限，结果不精确，这突出表明需要进一步研究，以便更深入地了解抗肿瘤药物治疗APTs和PCs的疗效。
