We describe the 20-year course of a 63-year-old male with a macroprolactinoma that acquired resistance to treatment and aggressive behavior after a 4-year successful treatment with cabergoline. He was submitted to multiple surgical resections by a skilled surgeon, fractionated radiotherapy and was eventually treated with temozolomide. After a first 6-month standard cycle, a relapse occurred and he was treated again successfully.
- Prolactinomas are the most frequent type of pituitary adenoma.
- They usually have a benign course.
- In most cases dopamine-agonist drugs, mainly cabergoline, are first-line (and usually only) treatment.
- Occasionally prolactinomas can have or acquire resistance to treatment and/or aggressive behavior.
- Temozolomide (TMZ), an oral alkylating drug, can be effective in such aggressive tumors.
- Multimodal treatment (surgery, radiation, cabergoline and TMZ) is warranted in aggressive pituitary tumors.
- We describe here successful rechallenge with TMZ after relapse occurring 18 months after a first TMZ cycle.