Immunotherapy in aggressive pituitary tumors and carcinomas: a systematic review

in Endocrine-Related Cancer
Authors:
Mirela Diana Ilie Inserm U1052, CNRS UMR5286, Claude Bernard Lyon 1 University, Cancer Research Center of Lyon, Lyon, France
Endocrinology Department, ‘C.I. Parhon’ National Institute of Endocrinology, Bucharest, Romania

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https://orcid.org/0000-0001-7248-7258
,
Alexandre Vasiljevic Inserm U1052, CNRS UMR5286, Claude Bernard Lyon 1 University, Cancer Research Center of Lyon, Lyon, France
Pathology Department, Reference Center for Rare Pituitary Diseases HYPO, ‘Groupement Hospitalier Est’ Hospices Civils de Lyon, Bron, France

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,
Emmanuel Jouanneau Inserm U1052, CNRS UMR5286, Claude Bernard Lyon 1 University, Cancer Research Center of Lyon, Lyon, France
Neurosurgery Department, Reference Center for Rare Pituitary Diseases HYPO, ‘Groupement Hospitalier Est’ Hospices Civils de Lyon, Bron, France

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, and
Gérald Raverot Inserm U1052, CNRS UMR5286, Claude Bernard Lyon 1 University, Cancer Research Center of Lyon, Lyon, France
Endocrinology Department, Reference Center for Rare Pituitary Diseases HYPO, ‘Groupement Hospitalier Est’ Hospices Civils de Lyon, Bron, France

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https://orcid.org/0000-0002-9517-338X

Correspondence should be addressed to M D Ilie: mireladiana.ilie@gmail.com
DOI:
https://doi.org/10.1530/ERC-22-0037
Volume/Issue:
Volume 29: Issue 7
Article Type:
Research Article
Page Range:
415–426
Online Publication Date:
27 May 2022
Copyright:
© Society for Endocrinology 2022
Restricted access
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Once temozolomide has failed, there is no recommended treatment option for pituitary carcinomas and aggressive pituitary tumors. Immune-checkpoint inhibitors (ICIs) represent the most recent therapeutic avenue, having raised hope with the publication of the first successful case in 2018. Here, we present an overview of immunotherapy in pituitary carcinomas and aggressive pituitary tumors, starting with the rationale for using ICIs and the implications of tumor-infiltrating lymphocytes in anterior pituitary tumors, followed by a systematic review of all published cases, analyzing both treatment response and potential predictors of response and finishing with research and clinical perspectives. Seven corticotroph and four lactotroph tumors have been so far treated with ICIs. Corticotroph tumors showed radiological partial response in 57% of cases, followed by stable disease in 29% of cases, which was accompanied by biochemical partial or complete response in 83% of cases. Half of lactotroph tumors showed radiological complete or partial response, accompanied by biochemical complete response in 33% of the cases. In the case of a dissociate response, continuation of immunotherapy combined with local treatment represents a good option. At this time, a high tumor mutational burden appears to be the most promising predictive marker of response. MMR deficiency does not guarantee a response. Negative PD-L1 staining should not preclude ICIs administration. Therefore, ICIs are a promising option after temozolomide failure. This review highlights key clinical aspects that can already be implemented into practice and also discusses tumor biology concepts and perspectives expected to improve immunotherapy outcomes.

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Print ISSN:
1351-0088
Online ISSN:
1479-6821
Copyright:
© Society for Endocrinology 2022
Page(s):
12
Received Date:
28 Mar 2022
Accepted Date:
28 Apr 2022
Print Publication Date:
01 Jul 2022
Online Publication Date:
27 May 2022
Keywords:
immunotherapy; immune-checkpoint inhibitors; ipilimumab; nivolumab; pembrolizumab; pituitary carcinoma; aggressive pituitary tumors; corticotroph; lactotroph; tumor-infiltrating lymphocytes (TILs)

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