Aggressive Macroprolactinoma Refractory to Multiple Lines of Localized and Systemic Therapy.

Aggressive prolactinomas are rare and pose considerable therapeutic challenges, especially in cases refractory to conventional treatments, including dopamine agonists, surgery, and radiotherapy. We present a case of a 77-year-old man with refractory, treatment-resistant macroprolactinoma and describe the sequential use of capecitabine temozolomide, olaparib bevacizumab, pembrolizumab, and pazopanib. Despite disease progression on multiple lines of therapy, pazopanib achieved disease stability, after which the tumor demonstrated slow progression. This case highlights the urgent need for novel therapeutic approaches and predictive biomarkers in managing refractory aggressive prolactinomas.