Hydroxychloroquine overcomes cabergoline resistance in a patient with Lactotroph Pituitary neuroendocrine tumor: a case report

Abstract

ObjectiveA 22-year-old man complaining erectile dysfunction underwent transsphenoidal surgery for a 2.7 cm sellar mass with total resection and was confirmed at pathology to have a lactotroph pituitary neuroendocrine tumor (PiNET). Postoperatively, the patient’s PRL remained at high level and therefore accepted high-dose dopamine receptor agonist (DA) therapy. After over 3 months of bromocriptine (BRC) (15mg/day) and over 3 years of cabergoline (CAB) (3mg/week) therapy, the patient’s prolactin (PRL) never achieved long-term normalization. He was diagnosed with DA-resistant lactotroph PitNET.MethodIn this study, the patient was given hydroxychloroquine (HCQ) (200 mg/d) and CAB (3 mg/w) in combination for four months. His PRL level was tested by blood test every month.ResultsTaking the combination therapy of HCQ and CAB, the patient’s uncontrolled PRL level was normalized within one month and was maintained at the normal level thereafter. Pituitary magnetic resonance imaging (MRI) images with enhancement showed no recurrence. The patient also regained normal sexual function.DiscussionThis is the first report on the combination of HCQ with CAB for the effective treatment of DA-resistant lactotroph pituitary neuroendocrine tumor in a patient, which might provide a novel treatment strategy for clinical management.

Therapeutic potential of targeting Nrf2 by panobinostat in pituitary neuroendocrine tumors

“…We previously identified the combination of Cabergoline and Chloroquine as a promising drug combination, which had potent synergy in PitNET treatment [ 32 ]. That study led to ongoing clinical trials of combination therapy in the drug-resistant prolactinomas (NCT02536261) [ 33 ]. Given the role Nrf2 played in the PitNET pathogenesis, it would be of importance exploring the effects of combination treatment of Panobinostat and Nrf2 inhibitor.…”

Single-cell transcriptomics reveal distinct immune-infiltrating phenotypes and macrophage–tumor interaction axes among different lineages of pituitary neuroendocrine tumors

“…TIME is a well-recognized factor in the development and progression of PitNETs [ 14 – 16 ]. Macrophages and T lymphocytes are the most prevalent infiltrating immune cells in PitNETs [ 17 , 18 ]. Also, other immune cell subtypes such as B lymphocytes, FOXP3 + cells, neutrophils, NK cells, or mast cells may be present less frequently [ 15 ].…”