<p>The management of aggressive pituitary tumors and carcinomas remains challenging. This review article discusses available treatments in relation to the recently published Revised European Society of Endocrinology Clinical Practice Guideline for the management of aggressive pituitary tumors and pituitary carcinomas. Specifically, we discuss both established treatment options, with a focus on temozolomide, and emerging treatment options. Regarding the emerging treatment options, we focus on molecular-guided druggable targets, immune-checkpoint inhibitors, bevacizumab and peptide receptor radionuclide therapy. For each treatment option, we discuss tumor response, predictive factors of response to treatment, adverse events, as well as perspectives.</p> Graphical Abstract <p></p>