Therapeutic Response of a Patient with Aggressive Prolactinoma Using Pazopanib: Case Report and Literature Review

Background: Prolactinomas are benign neoplasms usually responsive to dopamine agonist therapy. Rarely, these tumors exhibit aggressive features, including local invasiveness, high proliferation profile, resistance to medical therapy, and recurrence after surgery. Progression into carcinomas has also been reported. Understanding the molecular underpinnings of these tumors is critical to elucidate their pathogenesis and to create targeted therapy. This study aims to describe the treatment of an aggressive prolactinoma with pazopanib, followed by a literature review of the molecular findings in aggressive prolactinomas.

Methods: Our clinical database was retrospectively reviewed for patients with aggressive prolactinomas. The PubMed library was searched and screened for published literature pertaining to molecular biomarkers and targeting in aggressive prolactinomas. Screening for duplicates, non-English language, and relevance was conducted.

Results: We present one clinical case from our center demonstrating aggressive characteristics with thorough molecular characterization, and novel treatment modalities. We found 77 published articles that met our search criteria for molecular targeting in aggressive prolactinomas. Genomic and molecular sequencing of the tumor detected complex abnormalities in 18 chromosomes, involving the CDKN2A, CDKN2B, and TP53 genes, with increased PD-L1 expression. The patient was treated with pazopanib, a multitargeted receptor tyrosine kinase inhibitor, with a therapeutic response. Published articles that were reviewed include genetic, epigenetic, cell surface receptor, molecular pathway, and proteomic studies.

Conclusion: Aggressive prolactinomas are complex tumors that require a multidisciplinary approach for their treatment. Here we present the unusual case of an aggressive prolactinoma, with insight into its molecular abnormalities and with a good result after a novel treatment modality. Numerous articles have been published describing the molecular targets and/or potential biomarkers. Although some progress has been made, further studies are required to understand the molecular mechanisms and manage these aggressive tumors effectively, aiming toward precision medicine.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
01 February 2023