Impact of pre-treatment with somatostatin analogs on surgical management of acromegalic patients referred to a single center

Bacigaluppi, Susanna; Gatto, Federico; Anania, Pasquale; Bragazzi, Nicola Luigi; Rossi, Diego Criminelli; Benvegnù, Giulia; Nazzari, Elena; Spaziante, Renato; Giusti, Massimo; Ferone, Diego; Zona, Gianluigi

doi:10.1007/s12020-015-0619-5

Cited by 12 publications

(6 citation statements)

References 44 publications

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“…In more detail, latest Consensus Statements and guidelines on acromegaly suggest to consider first-line treatment with SRLs in patients with contraindications to or who refuse surgery, and in those subjects considered at poor risk for good outcomes and surgical success (9,10). Moreover, data concerning preoperative treatment with SRLs are conflicting in terms of improved surgical outcomes and biochemical control, and therefore their use in treatment-naïve acromegaly patients is still debated (11)(12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

“…%Ki67 labeling) (33,34), cannot be considered. Furthermore, most studies investigating the response to SRL first-line treatment have been carried out in the setting of preoperative SRL therapy, therefore focusing on the impact of medical treatment on both short-and long-term surgical outcome, as well as surgical complications (12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

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Clinical and Radiological Predictors of Biochemical Response to First-Line Treatment With Somatostatin Receptor Ligands in Acromegaly: A Real-Life Perspective

et al. 2021

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BackgroundFirst-generation somatostatin receptor ligands (fg-SRLs) represent the first-line medical treatment for acromegaly, recommended in patients with persistent disease after neurosurgery, or when surgical approach is not feasible. Despite the lack of strong recommendations from guidelines and consensus statements, data from national Registries report an increasing use of medical therapy as first-line treatment in acromegaly.ObjectiveWe retrospectively evaluated the potential role of a large number of clinical and radiological parameters in predicting the biochemical response to 6-month treatment with fg-SRLs, in a cohort of naïve acromegaly patients referred to a single tertiary center for pituitary diseases.MethodsUnivariable and multivariable logistic regression and linear regression analyses were performed. Biochemical response was defined based on IGF-1 levels, represented as both categorical (tight control, control, >50% reduction) and continuous (linear % reduction) variables.ResultsFifty-one patients (33 females, median age 57 years) were included in the study. At univariable logistic regression analysis, we found that younger age (≤ 40 years; OR 0.04, p=0.045) and higher BMI (OR 0.866, p=0.034) were associated with a lower chance of achieving >50% IGF-1 reduction. On the contrary, higher IGF-1 xULN values at diagnosis (OR 2.304, p=0.007) and a T2-hypointense tumor (OR 18, p=0.017) were associated with a significantly higher likelihood of achieving >50% IGF-1 reduction after SRL therapy. Of note, dichotomized age, IGF1 xULN at diagnosis, and T2-hypointense signal of the tumor were retained as significant predictors by our multivariable logistic regression model. Furthermore, investigating the presence of predictors to the linear % IGF-1 reduction, we found a negative association with younger age (≤ 40 years; β -0.533, p<0.0001), while a positive association was observed with both IGF-1 xULN levels at diagnosis (β 0.330, p=0.018) and the presence of a T2-hypointense pituitary tumor (β 0.466, p=0.019). All these variables were still significant predictors at multivariable analysis.ConclusionsDichotomized age, IGF-1 levels at diagnosis, and tumor T2-weighted signal are reliable predictors of both >50% IGF-1 reduction and linear % IGF-1 reduction after 6 month fg-SRL treatment in naïve acromegaly patients. These parameters should be considered in the light of an individualized treatment for acromegaly patients.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical and Radiological Predictors of Biochemical Response to First-Line Treatment With Somatostatin Receptor Ligands in Acromegaly: A Real-Life Perspective

et al. 2021

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“…15 First-generation SRLs, such as octreotide (OCT) LAR (long-acting release) and lanreotide (LAN) Autogel, are recommended in patients with persistent disease after surgery, and as first-line treatment for those ineligible for surgery, whereas their role in neo-adjuvant settings is still debated. 14,16 Radiotherapy remains an option in aggressive resistant tumors. 17 The aims of treatment in patients with acromegaly are GH and/or IGF-1 levels normalization, tumor mass control and preservation of the remaining pituitary function, amelioration of signs and symptoms, management of comorbidities, as well as reduction of mortality.…”

Section: Introductionmentioning

confidence: 99%

<p>Octreotide-Resistant Acromegaly: Challenges and Solutions</p>

Corica¹,

Ceraudo²,

Campana³

et al. 2020

TCRM

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Acromegaly is a rare and severe disease caused by an increased and autonomous secretion of growth hormone (GH), thus resulting in high circulating levels of insulin-like growth factor 1 (IGF-1). Comorbidities and mortality rate are closely related to the disease duration. However, in most cases achieving biochemical control means reducing or even normalizing mortality and restoring normal life expectancy. Current treatment for acromegaly includes neurosurgery, radiotherapy and medical therapy. Transsphenoidal surgery often represents the recommended first-line treatment. First-generation somatostatin receptor ligands (SRLs) are the drug of choice in patients with persistent disease after surgery and are suggested as first-line treatment for those ineligible for surgery. However, only about half of patients treated with octreotide (or lanreotide) achieve biochemical control. Other available drugs approved for clinical use are the second-generation SRL pasireotide, the dopamine agonist cabergoline, and the GH-receptor antagonist pegvisomant. In the present paper, we revised the current literature about the management of acromegaly, aiming to highlight the most relevant and recent therapeutic strategies proposed for patients resistant to first-line medical therapy. Furthermore, we discussed the potential molecular mechanisms involved in the variable response to first-generation SRLs. Due to the availability of different medical therapies, the choice for the most appropriate drug can be currently based also on the peculiar clinical characteristics of each patient.

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“…Current literature indicates that in acromegaly patients with macroadenoma (>10 mm), preoperative SSA treatment improves the surgical outcomes (2,5,19,28). Response to SSA treatment is highly variable among patients with acromegaly.…”

Section: Discussionmentioning

confidence: 99%

Added value of dynamic contrast-enhanced magnetic resonance imaging in predicting response to somatostatin analogs in patients with acromegaly

Durmaz

Koçak²,

Kadıoğlu³

et al. 2019

Turkish Neurosurgery

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AIM:To investigate the added value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) sequences in predicting somatostatin analog (SSA) responses in patients with acromegaly. MATERIAL and METHODS:This study included 55 active acromegaly patients with macroadenoma. Mean and maximum signal intensities were measured using region of interests in T2-weighted (T2W) and DCE-MRI sequences. Semi-quantitative values indicating relative signal intensity ratios and contrast-enhanced kinetics were obtained. Bivariate and multivariate analyses were used to determine whether the pathological granulation pattern of adenomas (dense versus others) was associated with patients' demographic variables and semi-quantitative MRI parameters. RESULTS:Three parameters formed the logistic model, χ2(3)=23.278, p<0.0001: age (odds ratio [OR]=1.08), hypointensity of adenomas in T2W images (OR=15.45), and high maximum enhancement ratio in the second interval (ER2 max ) values (OR=2195.74). The overall accuracy of this model was 85.45% with an area under the curve of 0.880. Sensitivity, specificity, positive predictive, and negative predictive values of the model were 68.75%, 92.31%, 78.58%, and 87.8%, respectively. CONCLUSION:In patients with newly diagnosed acromegaly, the model created based on the relative T2W signal intensity, patient's age, and ER2 max parameter from DCE-MRI sequences might be used to more accurately predict SSA responses.

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Impact of pre-treatment with somatostatin analogs on surgical management of acromegalic patients referred to a single center

Cited by 12 publications

References 44 publications

Clinical and Radiological Predictors of Biochemical Response to First-Line Treatment With Somatostatin Receptor Ligands in Acromegaly: A Real-Life Perspective

Clinical and Radiological Predictors of Biochemical Response to First-Line Treatment With Somatostatin Receptor Ligands in Acromegaly: A Real-Life Perspective

<p>Octreotide-Resistant Acromegaly: Challenges and Solutions</p>

Added value of dynamic contrast-enhanced magnetic resonance imaging in predicting response to somatostatin analogs in patients with acromegaly

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