Efficacy of pasireotide lar in first line somatostatin analogue resistant acromegaly patients: experience from a large and single centre Italian cohort

Chiloiro, Sabrina; Giampietro, Antonella; Bianchi, Antonio; Tartaglione, Tommaso; Bima, Chiara; Piacentini, Serena; Mirra, Federica; Donfrancesco, Federico; Lauretti, Liverana; Anile, Carmelo; Pontecorvi, Alfredo; De, Marinis Laura

doi:10.1530/endoabs.56.p875

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“…However, it has also to be accepted that this combination may increase the possibility of complications such as diabetes, and the drug is of high cost. The combination of pasireotide LAR, pegvisomant, and cabergoline was also used in an Italian cohort of patients with aggressive resistant acromegaly [31], while a meta-analysis suggested that the addition of cabergoline in patients resistant to first-generation SSAs resulted in normalization of IGF-1 in around 50% of cases, even in patients with normoprolactinemia [32]. However, in this specific case its efficacy and value remain uncertain, and it is usually most useful where levels of IGF1 are only mildly elevated [6].…”

Section: Discussionmentioning

confidence: 99%

Role of Receptor Profiling for Personalized Therapy in a Patient with a Growth Hormone-Secreting Macroadenoma Resistant to First-Generation Somatostatin Analogues

Alexandraki

Papadimitriou

Mavroeidi

et al. 2019

JPM

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Background: Acromegaly is almost always caused by a pituitary adenoma and is associated with high morbidity and mortality when uncontrolled. Trans-sphenoidal removal of the adenoma is the mainstay of therapy, but fails to control the disease in a significant number of patients who require further treatment. Somatostatin analogues (SSAs) as monotherapy or in combination with growth hormone (GH)-receptor antagonists and/or dopamine agonists are used either alone or in combination following surgical failure to achieve disease control. The use of specific biomarkers may help to individualize the therapeutic plan after surgical failure and direct towards a more personalized approach. Methods: We report a 41-year-old man with acromegaly and residual disease after repeated surgery that was resistant to first-generation SSAs. Results: Biochemical and tumor control were achieved following the administration of a second-generation SSA, pasireotide, combined with pegvisomant, both at maximal doses and along with cabergoline. Histology specimens showed a sparsely-granulated GH-immunostaining pituitary adenoma with intense positivity for somatostatin receptors 2 and 5 and low levels of E-cadherin. Conclusion: Personalized medical therapy guided by currently available biomarkers, such as immunohistochemically-characterized receptor profiling or adhesion molecules, resulted in controlled insulin-like growth factor-1 (IGF-1) and GH levels and symptom alleviation following the combination of three drug-classes.

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Section: Discussionmentioning

confidence: 99%