{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T06:22:17Z","timestamp":1787898137190,"version":"build-2784847793"},"reference-count":73,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T00:00:00Z","timestamp":1753228800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>When non-functioning pituitary adenomas (NFPAs) behave aggressively or recur after first-line surgical treatment, it can be challenging to decide whether and how to escalate therapy. Up to 47% of patients with residual tumor after transsphenoidal surgery will show disease recurrence or progression and may require an intervention. Repeat surgical resection can be attempted in select cases if the tumor is accessible; for the remainder of patients, non-surgical treatment options may need to be considered. Radiotherapy can control tumor growth in 75% of NFPAs, but confers increased risk of hypopituitarism and other disorders. Currently, there are no medical therapies approved for patients with recurrent or aggressive NFPA. However, several have been investigated, including temozolomide, somatostatin receptor ligands, dopamine agonists, immune checkpoint inhibitors, vascular endothelial growth factor inhibitors, and peptide receptor radionuclide therapy. We present a review of the available evidence to provide guidance for pituitary endocrinologists and neuro-oncologists when treating patients with recurrent or aggressive NFPA.<\/jats:p>","DOI":"10.3390\/jcm14155203","type":"journal-article","created":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T08:02:06Z","timestamp":1753257726000},"page":"5203","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Management of Recurrent and Aggressive Non-Functioning Pituitary Adenomas"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2724-078X","authenticated-orcid":false,"given":"Nicole A.","family":"Hefner","sequence":"first","affiliation":[{"name":"Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5955-8242","authenticated-orcid":false,"given":"Odelia","family":"Cooper","sequence":"additional","affiliation":[{"name":"Pituitary Center, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1210\/endrev\/bnac010","article-title":"Clinical Biology of the Pituitary Adenoma","volume":"43","author":"Melmed","year":"2022","journal-title":"Endocr. Rev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1038\/s41574-021-00550-w","article-title":"Aggressive Pituitary Tumours and Pituitary Carcinomas","volume":"17","author":"Raverot","year":"2021","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_3","first-page":"284","article-title":"Therapeutic approach to non-functioning pituitary adenomas","volume":"156","year":"2021","journal-title":"Med. Cl\u00ednica"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1093\/ejendo\/lvad070","article-title":"Natural History of Non-Functioning Pituitary Microadenomas: Results from the UK Non-Functioning Pituitary Adenoma Consortium","volume":"189","author":"Hamblin","year":"2023","journal-title":"Eur. J. Endocrinol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1007\/s12020-016-0940-7","article-title":"Non-Functioning Pituitary Adenomas: Growth and Aggressiveness","volume":"53","author":"Evang","year":"2016","journal-title":"Endocrine"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Solari, D., Cavallo, L.M., Graziadio, C., Corvino, S., Bove, I., Esposito, F., and Cappabianca, P. (2022). Giant Non-Functioning Pituitary Adenomas: Treatment Considerations. Brain Sci., 12.","DOI":"10.3390\/brainsci12091256"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Lu, L., Wan, X., Xu, Y., Chen, J., Shu, K., and Lei, T. (2022). Classifying Pituitary Adenoma Invasiveness Based on Radiological, Surgical and Histological Features: A Retrospective Assessment of 903 Cases. J. Clin. Med., 11.","DOI":"10.3390\/jcm11092464"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"63","DOI":"10.14791\/btrt.2016.4.2.63","article-title":"Therapeutic Strategy for Cavernous Sinus-Invading Non-Functioning Pituitary Adenomas Based on the Modified Knosp Grading System","volume":"4","author":"Hwang","year":"2016","journal-title":"Brain Tumor Res. Treat."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1530\/EJE-10-0255","article-title":"Factors Predicting Relapse of Nonfunctioning Pituitary Macroadenomas after Neurosurgery: A Study of 142 Patients","volume":"163","author":"Brochier","year":"2010","journal-title":"Eur. J. Endocrinol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1007\/s00701-024-06296-4","article-title":"Stereotactic Radiosurgery for Recurrent\/Residual Nonfunctioning Pituitary Adenoma: A Single-Arm Systematic Review and Meta-Analysis","volume":"166","author":"Vilela","year":"2024","journal-title":"Acta Neurochir."},{"key":"ref_11","first-page":"e51","article-title":"Stereotactic Radiosurgery and Hypofractionated Stereotactic Radiotherapy for Nonfunctioning Pituitary Adenoma","volume":"82","author":"Khattab","year":"2020","journal-title":"J. Neurol. Surg. Part B Skull Base"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1038\/nrendo.2014.64","article-title":"Aggressive Pituitary Adenomas\u2014Diagnosis and Emerging Treatments","volume":"10","author":"Rotondo","year":"2014","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"G1","DOI":"10.1530\/EJE-17-0796","article-title":"European Society of Endocrinology Clinical Practice Guidelines for the Management of Aggressive Pituitary Tumours and Carcinomas","volume":"178","author":"Raverot","year":"2018","journal-title":"Eur. J. Endocrinol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1383","DOI":"10.3174\/ajnr.A2170","article-title":"Temozolomide (Temodar)","volume":"31","author":"Wesolowski","year":"2010","journal-title":"Am. J. Neuroradiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/j.coph.2006.03.011","article-title":"Exploiting the Role of O6-Methylguanine-DNA-Methyltransferase (MGMT) in Cancer Therapy","volume":"6","author":"Sabharwal","year":"2006","journal-title":"Curr. Opin. Pharmacol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1016\/S1470-2045(06)70728-8","article-title":"Temozolomide: A Novel Treatment for Pituitary Carcinoma","volume":"7","author":"Lim","year":"2006","journal-title":"Lancet Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Lamas, C., C\u00e1mara, R., Fajardo, C., Remon-Ruiz, P., Biagetti, B., Guerrero-P\u00e9rez, F., Araujo-Castro, M., Mora, M., Hanzu, F., and Iglesias, P. (2023). Efficacy and Safety of Temozolomide in the Treatment of Aggressive Pituitary Neuroendocrine Tumours in Spain. Front. Endocrinol., 14.","DOI":"10.3389\/fendo.2023.1204206"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1093\/nop\/npv059","article-title":"Temozolomide Treatment of Pituitary Carcinomas and Atypical Adenomas: Systematic Review of Case Reports","volume":"3","author":"Ji","year":"2016","journal-title":"Neuro-Oncol. Pract."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1007\/s11102-016-0745-y","article-title":"How Effective Is Temozolomide for Treating Pituitary Tumours and When Should It Be Used?","volume":"20","author":"Halevy","year":"2017","journal-title":"Pituitary"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1530\/EJE-17-0933","article-title":"Treatment of Aggressive Pituitary Tumours and Carcinomas: Results of a European Society of Endocrinology (ESE) Survey 2016","volume":"178","author":"McCormack","year":"2018","journal-title":"Eur. J. Endocrinol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Das, L., Gupta, N., Dutta, P., Walia, R., Vaiphei, K., Rai, A., Radotra, B.D., Gupta, K., Sreedharanunni, S., and Ahuja, C.K. (2021). Early Initiation of Temozolomide Therapy May Improve Response in Aggressive Pituitary Adenomas. Front. Endocrinol., 12.","DOI":"10.3389\/fendo.2021.774686"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"T159","DOI":"10.1530\/ERC-18-0015","article-title":"65 YEARS OF THE DOUBLE HELIX: Treatment of Pituitary Tumors with Temozolomide: An Update","volume":"25","author":"Syro","year":"2018","journal-title":"Endocr.-Relat. Cancer"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"R545","DOI":"10.1530\/ERC-19-0083","article-title":"How and When to Use Temozolomide to Treat Aggressive Pituitary Tumours","volume":"26","author":"Whitelaw","year":"2019","journal-title":"Endocr.-Relat. Cancer"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1350","DOI":"10.1093\/neuonc\/now059","article-title":"Is There a Role for Early Chemotherapy in the Management of Pituitary Adenomas?","volume":"18","author":"Lin","year":"2016","journal-title":"Neuro-Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1007\/s11060-008-9764-5","article-title":"Extended Exposure to Alkylator Chemotherapy: Delayed Appearance of Myelodysplasia","volume":"93","author":"Chamberlain","year":"2009","journal-title":"J. Neuro-Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Gomes-Porras, M., C\u00e1rdenas-Salas, J., and \u00c1lvarez-Escol\u00e1, C. (2020). Somatostatin Analogs in Clinical Practice: A Review. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21051682"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1530\/eje.0.1460707","article-title":"SOM230: A Novel Somatostatin Peptidomimetic with Broad Somatotropin Release Inhibiting Factor (SRIF) Receptor Binding and a Unique Antisecretory Profile","volume":"146","author":"Bruns","year":"2002","journal-title":"Eur. J. Endocrinol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1158\/1078-0432.CCR-19-2154","article-title":"A Somatostatin Receptor Subtype-3 (SST3) Peptide Agonist Shows Antitumor Effects in Experimental Models of Nonfunctioning Pituitary Tumors","volume":"26","author":"Gupta","year":"2020","journal-title":"Clin. Cancer Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1007\/s11102-011-0370-8","article-title":"Treatment with Octreotide LAR in Clinically Non-Functioning Pituitary Adenoma: Results from a Case\u2013Control Study","volume":"15","author":"Fusco","year":"2012","journal-title":"Pituitary"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1677\/ERC-06-0026","article-title":"Pasireotide, a Multiple Somatostatin Receptor Subtypes Ligand, Reduces Cell Viability in Non-Functioning Pituitary Adenomas by Inhibiting Vascular Endothelial Growth Factor Secretion","volume":"14","author":"Zatelli","year":"2007","journal-title":"Endocr.-Relat. Cancer"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1530\/JOE-16-0332","article-title":"Octreotide and Pasireotide (Dis)Similarly Inhibit Pituitary Tumor Cells in Vitro","volume":"231","author":"Gahete","year":"2016","journal-title":"J. Endocrinol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1530\/eje.0.1480357","article-title":"Pharyngeal Pituitary Non-Functioning Adenoma with Normal Intra-Sellar Gland: Massive Tumor Shrinkage on Octreotide Therapy","volume":"148","author":"Pugnale","year":"2003","journal-title":"Eur. J. Endocrinol."},{"key":"ref_33","first-page":"100923","article-title":"Lanreotide versus Placebo for Tumour Reduction in Patients with a 68Ga-DOTATATE PET-Positive, Clinically Non-Functioning Pituitary Macroadenoma (GALANT Study): A Randomised, Multicentre, Phase 3 Trial with Blinded Outcome Assessment","volume":"42","author":"Boertien","year":"2024","journal-title":"Lancet Reg. Health-Eur."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.1111\/jgh.16638","article-title":"Gastrointestinal Side Effects of Somatostatin Analogs in Neuroendocrine Tumors: A Focused Review","volume":"39","author":"Marasco","year":"2024","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"R233","DOI":"10.1530\/ERC-10-0334","article-title":"The Role of Somatostatin and Dopamine D2 Receptors in Endocrine Tumors","volume":"18","author":"Gatto","year":"2011","journal-title":"Endocr. -Relat. Cancer"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Cooper, O., and Greenman, Y. (2018). Dopamine Agonists for Pituitary Adenomas. Front. Endocrinol., 9.","DOI":"10.3389\/fendo.2018.00469"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1007\/s11102-011-0316-1","article-title":"Dopamine 2 Receptor Expression in Various Pathological Types of Clinically Non-Functioning Pituitary Adenomas","volume":"15","author":"Gabalec","year":"2012","journal-title":"Pituitary"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1931","DOI":"10.1210\/jc.2008-1826","article-title":"Expression Analysis of Dopamine Receptor Subtypes in Normal Human Pituitaries, Nonfunctioning Pituitary Adenomas and Somatotropinomas, and the Association between Dopamine and Somatostatin Receptors with Clinical Response to Octreotide-LAR in Acromegaly","volume":"94","author":"Neto","year":"2009","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1097\/COC.0000000000000505","article-title":"Cabergoline in the Management of Residual Nonfunctioning Pituitary Adenoma: A Single-Center, Open-Label, 2-Year Randomized Clinical Trial","volume":"42","author":"Batista","year":"2019","journal-title":"Am. J. Clin. Oncol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1530\/EJE-16-0206","article-title":"Treatment of Clinically Nonfunctioning Pituitary Adenomas with Dopamine Agonists","volume":"175","author":"Greenman","year":"2016","journal-title":"Eur. J. Endocrinol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1007\/s11102-012-0380-1","article-title":"Cabergoline Reduces Cell Viability in Non Functioning Pituitary Adenomas by Inhibiting Vascular Endothelial Growth Factor Secretion","volume":"16","author":"Gagliano","year":"2013","journal-title":"Pituitary"},{"key":"ref_42","first-page":"506","article-title":"Efficacy of Cabergoline Therapy in Patients with Non-Functioning Pituitary Adenomas: A Single Center Clinical Experience","volume":"66","author":"Mercado","year":"2022","journal-title":"Arch. Endocrinol. Metab."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1007\/s11102-023-01365-w","article-title":"Cabergoline Treatment for Surgery-Na\u00efve Non-Functioning Pituitary Macroadenomas","volume":"27","author":"Turjeman","year":"2024","journal-title":"Pituitary"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1007\/s11102-022-01257-5","article-title":"Treatment of Non-Functioning Pituitary Adenoma with Cabergoline: A Systematic Review and Meta-Analysis","volume":"25","author":"Botelho","year":"2022","journal-title":"Pituitary"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1007\/s11102-018-0865-7","article-title":"Management of NFAs: Medical Treatment","volume":"21","author":"Greenman","year":"2018","journal-title":"Pituitary"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1111\/1440-1681.13678","article-title":"Bromocriptine Therapy: Review of Mechanism of Action, Safety and Tolerability","volume":"49","author":"Naz","year":"2022","journal-title":"Clin. Exp. Pharmacol. Physiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1016\/j.lfs.2005.05.061","article-title":"The Effect of Selective Sst1, Sst2, Sst5 Somatostatin Receptors Agonists, a Somatostatin\/Dopamine (SST\/DA) Chimera and Bromocriptine on the \u201cClinically Non-Functioning\u201d Pituitary Adenomas in Vitro","volume":"78","author":"Gruszka","year":"2006","journal-title":"Life Sci."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1677\/ERC-07-0271","article-title":"Efficacy of a Dopamine-Somatostatin Chimeric Molecule, BIM-23A760, in the Control of Cell Growth from Primary Cultures of Human Non-Functioning Pituitary Adenomas: A Multi-Center Study","volume":"15","author":"Florio","year":"2008","journal-title":"Endocr.-Relat. Cancer"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/j.canlet.2009.06.034","article-title":"The Dopamine\u2013Somatostatin Chimeric Compound BIM-23A760 Exerts Antiproliferative and Cytotoxic Effects in Human Non-Functioning Pituitary Tumors by Activating ERK1\/2 and P38 Pathways","volume":"288","author":"Peverelli","year":"2010","journal-title":"Cancer Lett."},{"key":"ref_50","first-page":"439","article-title":"Long-Term Effect of Combined Therapy with Somatostatin Analogs and Dopamine Agonists as a Primary Treatment in a Non-Functioning Invasive Pituitary Macroadenoma","volume":"68","author":"Iglesias","year":"2021","journal-title":"Endocrinol. Diabetes Y Nutr. (Engl. Ed.)"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Dai, C., Liang, S., Sun, B., and Kang, J. (2020). The Progress of Immunotherapy in Refractory Pituitary Adenomas and Pituitary Carcinomas. Front. Endocrinol., 11.","DOI":"10.3389\/fendo.2020.608422"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1186\/s12943-025-02305-x","article-title":"Advances in Cancer Immunotherapy: Historical Perspectives, Current Developments, and Future Directions","volume":"24","author":"Zhang","year":"2025","journal-title":"Mol. Cancer"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"2053","DOI":"10.1007\/s00262-020-02611-x","article-title":"Expression of Programmed Death-Ligand 1 (PD-L1) in Human Pituitary Neuroendocrine Tumor","volume":"69","author":"Suteau","year":"2020","journal-title":"Cancer Immunol. Immunother."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1007\/s11060-020-03636-z","article-title":"Comprehensive Analysis of the Immunological Landscape of Pituitary Adenomas: Implications of Immunotherapy for Pituitary Adenomas","volume":"149","author":"Zhou","year":"2020","journal-title":"J. Neuro-Oncol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1007\/s11060-018-2844-2","article-title":"The Expression Profile of PD-L1 and CD8+ Lymphocyte in Pituitary Adenomas Indicating for Immunotherapy","volume":"139","author":"Wang","year":"2018","journal-title":"J. Neuro-Oncol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"3925","DOI":"10.1210\/jc.2018-01347","article-title":"Marked Response of a Hypermutated ACTH-Secreting Pituitary Carcinoma to Ipilimumab and Nivolumab","volume":"103","author":"Lin","year":"2018","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1530\/EJE-22-0440","article-title":"Aggressive Pituitary Tumours and Carcinomas, Characteristics and Management of 171 Patients","volume":"187","author":"Burman","year":"2022","journal-title":"Eur. J. Endocrinol."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Lin, A.L., Rudneva, V., Newton, A., Majd, N.K., Magge, R., Sengupta, S., Goichot, B., Piotrowski, A., Gavrilovic, I., and Cooper, O. (2025). Immune Checkpoint Inhibitor Therapy for Aggressive Pituitary Neuroendocrine Tumors. J. Clin. Endocrinol. Metab., dgaf178.","DOI":"10.1210\/clinem\/dgaf178"},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Lopes-Pinto, M., Lacerda-Nobre, E., Silva, A.L., and Marques, P. (2024). Therapeutical Usefulness of PD-1\/PD-L1 Inhibitors in Aggressive or Metastatic Pituitary Tumours. Cancers, 16.","DOI":"10.3390\/cancers16173033"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1038\/s41572-020-0160-6","article-title":"Immune-Related Adverse Events of Checkpoint Inhibitors","volume":"6","author":"Brahmer","year":"2020","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_61","unstructured":"(2025, May 26). Nivolumab and Ipilimumab in People with Aggressive Pituitary Tumors, Available online: https:\/\/clinicaltrials.gov\/study\/NCT04042753."},{"key":"ref_62","unstructured":"(2025, May 26). Nivolumab and Ipilimumab in Treating Patients with Rare Tumors, Available online: https:\/\/clinicaltrials.gov\/study\/NCT02834013."},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Sato, M., Tamura, R., Tamura, H., Mase, T., Kosugi, K., Morimoto, Y., Yoshida, K., and Toda, M. (2019). Analysis of Tumor Angiogenesis and Immune Microenvironment in Non-Functional Pituitary Endocrine Tumors. J. Clin. Med., 8.","DOI":"10.3390\/jcm8050695"},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Dai, C., Liang, S., Sun, B., Li, Y., and Kang, J. (2021). Anti-VEGF Therapy in Refractory Pituitary Adenomas and Pituitary Carcinomas: A Review. Front. Oncol., 11.","DOI":"10.3389\/fonc.2021.773905"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"102017","DOI":"10.1016\/j.ctrv.2020.102017","article-title":"Bevacizumab (Avastin\u00ae) in Cancer Treatment: A Review of 15 Years of Clinical Experience and Future Outlook","volume":"86","author":"Garcia","year":"2020","journal-title":"Cancer Treat. Rev."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1007\/s11102-011-0346-8","article-title":"Anti-VEGF Therapy in Pituitary Carcinoma","volume":"15","author":"Ortiz","year":"2012","journal-title":"Pituitary"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.jocn.2017.02.052","article-title":"Successful Treatment of Pituitary Carcinoma with Concurrent Radiation, Temozolomide, and Bevacizumab after Resection","volume":"41","author":"Touma","year":"2017","journal-title":"J. Clin. Neurosci."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Wang, L., Liu, W.-Q., Broussy, S., Han, B., and Fang, H. (2024). Recent Advances of Anti-Angiogenic Inhibitors Targeting VEGF\/VEGFR Axis. Front. Pharmacol., 14.","DOI":"10.3389\/fphar.2023.1307860"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"104144","DOI":"10.1016\/j.lpm.2022.104144","article-title":"Pituitary Adenoma & Nuclear Medicine: Recent Outcomes and Ongoing Developments","volume":"51","author":"Chevalier","year":"2022","journal-title":"La Presse M\u00e9dicale"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1007\/s11102-013-0540-y","article-title":"Peptide Receptor Radionuclide Therapy for Aggressive Atypical Pituitary Adenoma\/Carcinoma: Variable Clinical Response in Preliminary Evaluation","volume":"17","author":"Maclean","year":"2014","journal-title":"Pituitary"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1007\/s11102-013-0494-0","article-title":"Peptide Receptor Radionuclide Therapy in a Patient with Disabling Non-Functioning Pituitary Adenoma","volume":"17","author":"Komor","year":"2014","journal-title":"Pituitary"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1530\/EC-19-0065","article-title":"Peptide Receptor Radionuclide Therapy for Aggressive Pituitary Tumors: A Monocentric Experience","volume":"8","author":"Giuffrida","year":"2019","journal-title":"Endocr. Connect."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"R45","DOI":"10.1093\/ejendo\/lvaf100","article-title":"Revised European Society of Endocrinology Clinical Practice Guideline for the Management of Aggressive Pituitary Tumours and Pituitary Carcinomas","volume":"192","author":"Raverot","year":"2025","journal-title":"Eur. J. 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