MANAGEMENT OF ENDOCRINE DISEASE: Personalized medicine in the treatment of acromegaly

Abstract

Acromegaly is associated with high morbidity and elevated mortality when not adequately treated. Surgery is the first-line treatment for most patients as it is the only one that can lead to immediate cure. In patients who are not cured by surgery, treatment is currently based on a trial-and-error approach. Firstgeneration somatostatin receptor ligands (fg-SRL) are initiated for most patients, although approximately 25% of patients present resistance to this drug class. Some biomarkers of treatment outcome are described in the literature, with the aim of categorizing patients into different groups to individualize their treatments using a personalized approach. In this review, we will discuss the current status of precision medicine for the treatment of acromegaly and future perspectives on the use of personalized medicine for this purpose.

E‐cadherin expression is associated with somatostatin analogue response in acromegaly

“…In (B,C) data points represent values for each individual patient. 26,31 Hence, it seems that the potential connection negative linking E-cadherin and SSTR5 expression (and, perhaps, function) deserves to be explored in more detail. The Mann-Whitney test was used.…”

“…22,40 Finally, while the relationship between E-cadherin and SSTR5 expression is poorly know, it is worth noting that the expression of SSTR5 and some of its truncated variants comprises the only known markers among SSTRs for worse patient response to SSAs. 26,31 Hence, it seems that the potential connection negative linking E-cadherin and SSTR5 expression (and, perhaps, function) deserves to be explored in more detail.…”

“…[21][22][23][24][25] Of note, the granulation pattern of GH-producing tumours is considered a histological marker of response to SSAs treatment with SG somatotropinomas presenting a worse response to SSAs treatment. 26 Despite all these findings, the potential association between E-cadherin expression and SSAs response in GH-producing tumours has been barely studied to date. 14 Fougner et al 14 reported that loss of membranous E-cadherin expression and concomitant translocation of E-cadherin to the nucleus was associated with resistance to SSAs treatment in GH-producing tumours.…”

“…14,[17][18][19][20] However, the association between the loss of E-cadherin expression and aggressiveness of GH-producing tumours has yielded conflicting results. 26 Despite all these findings, the potential association between E-cadherin expression and SSAs response in GH-producing tumours has been barely studied to date. Thus, whereas high E-cadherin expression levels are found in densely granulated somatotroph adenomas (DGSAs) tumours, low or absent E-cadherin expression is observed in sparsely granulated somatotroph adenomas (SGSAs).…”

The place of medical treatment of acromegaly in Serbia: Current status

“…expression in tumor tissue, although SSTR2A expression is also a predictor of good response. 56 Better prognosis on pegvisomant treatment is anticipated in male patients, prior radiotherapy, and in some of GH receptor gene polymorphisms (lack of d3-RHR). AIP mutation positive patients and patients with McCune Albright syndrome are frequently resistant to SRL, thus making pegvisomant the drug of choice in these groups.…”