Therapeutic effect of presurgical treatment with longacting octreotide (Sandostatin® LAR®) in patients with acromegaly
, 2, 3, 45, 1, 26, 7, 8, 9, 10, 911, 911, 12, 913, 1,
Abstract
Introduction: The aim of this study was to assess the therapeutic effect and the safety of pre-surgical treatment with long-acting octreotide in patients with acromegaly. Material and methods: This project was conducted in 25 centres across Poland as a non-interventional, multicentre, observational study in patients with acromegaly, in which long-acting octreotide Sandostatin® LAR®) was administered before surgery. They were 148 patients included into the study: 88 females and 60 males aged 18–86 years (51.3 ± 13.4). Results: Eighty patients completed the study (underwent tumour surgery). The CRF included: baseline visit, four follow-up visits every three months before surgery, and two follow-up visits every three months after surgery. Sandostatin® LAR® was administered every four weeks. The efficacy measures were as follows: change of growth hormone (GH) and insulin-like growth factor 1 (IGF-1) levels, number of patients fulfilling criteria of cure, and change of adenoma (micro- and macroadenomas) size during the treatment. Normalisation of GH and IGF-1 concentrations were obtained in 42.4 and 49.1% of patients at the end of medical therapy, respectively. Normalisation of GH and IGF-1 concentrations were obtained in 77.9 and 83.8% of patients after surgery, respectively. Reduction of microadenoma size was documented in 58.8% of patients, and in 70% of patients with macroadenomas at the end of medical therapy. In 74.0% of patients no pituitary tumour was shown on MRI after surgery. Conclusion: We have shown good surgical outcome in patients with acromegaly after pre-treatment with somatostatin analogue, and good tolerance and safety of the therapy, supporting the national recommendation for pre-surgical treatment with long-acting somatostatin analogues in acromegaly patients.
Keywords: acromegalypresurgical pharmacotherapyneurosurgery
References
- Melmed S. Medical progress: Acromegaly. N Engl J Med. 2006; 355(24): 2558–2573.
- Bolfi F, Neves AF, Boguszewski CL, et al. Mortality in acromegaly decreased in the last decade: a systematic review and meta-analysis. Eur J Endocrinol. 2018; 179(1): 59–71.
- Katznelson L, Laws ER, Melmed S, et al. Endocrine Society. Acromegaly: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2014; 99(11): 3933–3951.
- Melmed S, Bronstein MD, Chanson P, et al. A Consensus Statement on acromegaly therapeutic outcomes. Nat Rev Endocrinol. 2018; 14(9): 552–561.
- Bolanowski M, Ruchała M, Zgliczyński W, et al. Diagnostics and treatment of acromegaly - updated recommendations of the Polish Society of Endocrinology. Endokrynol Pol. 2019; 70(1): 2–18.
- Carmichael JD, Bonert VS, Nuño M, et al. Acromegaly clinical trial methodology impact on reported biochemical efficacy rates of somatostatin receptor ligand treatments: a meta-analysis. J Clin Endocrinol Metab. 2014; 99(5): 1825–1833.
- Colao A, Ferone D, Cappabianca P, et al. Effect of octreotide pretreatment on surgical outcome in acromegaly. J Clin Endocrinol Metab. 1997; 82(10): 3308–3314.
- Oshino S, Saitoh Y, Kasayama S, et al. Short-term preoperative octreotide treatment of GH-secreting pituitary adenoma: predictors of tumor shrinkage. Endocr J. 2006; 53(1): 125–132.
- Carlsen SM, Lund-Johansen M, Schreiner T, et al. Preoperative Octreotide Treatment of Acromegaly study group. Preoperative octreotide treatment in newly diagnosed acromegalic patients with macroadenomas increases cure short-term postoperative rates: a prospective, randomized trial. J Clin Endocrinol Metab. 2008; 93(8): 2984–2990.
- Biermasz NR, van Dulken H, Roelfsema F. Direct postoperative and follow-up results of transsphenoidal surgery in 19 acromegalic patients pretreated with octreotide compared to those in untreated matched controls. J Clin Endocrinol Metab. 1999; 84(10): 3551–3555.
- Plöckinger U, Quabbe HJ. Presurgical octreotide treatment in acromegaly: no improvement of final growth hormone (GH) concentration and pituitary function. A long-term case-control study. Acta Neurochir (Wien). 2005; 147(5): 485–93; discussion 493.
- Losa M, Mortini P, Urbaz L, et al. Presurgical treatment with somatostatin analogs in patients with acromegaly: effects on the remission and complication rates. J Neurosurg. 2006; 104(6): 899–906.
- Nunes VS, Correa JMS, Puga MES, et al. Preoperative somatostatin analogues versus direct transsphenoidal surgery for newly-diagnosed acromegaly patients: a systematic review and meta-analysis using the GRADE system. Pituitary. 2015; 18(4): 500–508.
- Yang C, Li Ge, Jiang S, et al. Preoperative Somatostatin Analogues in Patients with Newly-diagnosed Acromegaly: A Systematic Review and Meta-analysis of Comparative Studies. Sci Rep. 2019; 9(1): 14070.
- Pita-Gutierrez F, Pertega-Diaz S, Pita-Fernandez S, et al. Place of preoperative treatment of acromegaly with somatostatin analog on surgical outcome: a systematic review and meta-analysis. PLoS One. 2013; 8(4): e61523.
- Zhang L, Wu X, Yan Y, et al. Preoperative somatostatin analogs treatment in acromegalic patients with macroadenomas. A meta-analysis. Brain Dev. 2015; 37(2): 181–190.
- Bolanowski M, Bar-Andziak E, Kos-Kudła B, et al. [Konsensus Polskiego Towarzystwa Endokrynologicznego. Przygotowanie analogami somatostatyny do leczenia operacyjnego akromegalii]. Endokrynol Pol. 2007; 58(4): 350–353.
- Petrossians P, Daly AF, Natchev E, et al. Acromegaly at diagnosis in 3173 patients from the Liège Acromegaly Survey (LAS) Database. Endocr Relat Cancer. 2017; 24(10): 505–518.
- Melmed S, Casanueva FF, Klibanski A, et al. Pituitary Society and the European Neuroendocrine Association. Diagnosis and treatment of acromegaly complications. J Endocrinol Invest. 2003; 26(12): 1242–1247.
- Cozzi R, Montini M, Attanasio R, et al. Primary treatment of acromegaly with octreotide LAR: a long-term (up to nine years) prospective study of its efficacy in the control of disease activity and tumor shrinkage. J Clin Endocrinol Metab. 2006; 91(4): 1397–1403.
- Caron PJ, Bevan JS, Petersenn S, et al. PRIMARYS Investigators. Tumor shrinkage with lanreotide Autogel 120 mg as primary therapy in acromegaly: results of a prospective multicenter clinical trial. J Clin Endocrinol Metab. 2014; 99(4): 1282–1290.
- Mao Zg, Zhu Yh, Tang Hl, et al. Preoperative lanreotide treatment in acromegalic patients with macroadenomas increases short-term postoperative cure rates: a prospective, randomised trial. Eur J Endocrinol. 2010; 162(4): 661–666.
- Shen M, Shou X, Wang Y, et al. Effect of presurgical long-acting octreotide treatment in acromegaly patients with invasive pituitary macroadenomas: a prospective randomized study. Endocr J. 2010; 57(12): 1035–1044.
- Duan L, Zhu H, Xing B, et al. Prolonged preoperative treatment of acromegaly with Somatostatin analogs may improve surgical outcome in patients with invasive pituitary macroadenoma (Knosp grades 1-3): a retrospective cohort study conducted at a single center. BMC Endocr Disord. 2017; 17(1): 55.
- Lv L, Hu Yu, Zhou P, et al. Presurgical treatment with somatostatin analogues in growth hormone-secreting pituitary adenomas: A long-term single-center experience. Clin Neurol Neurosurg. 2018; 167: 24–30.
- Albarel F, Castinetti F, Morange I, et al. Pre-surgical medical treatment, a major prognostic factor for long-term remission in acromegaly. Pituitary. 2018; 21(6): 615–623.
- Polat Korkmaz O, Gurcan M, Nuhoglu Kantarci FE, et al. The effects of pre-operative somatostatin analogue therapy on treatment cost and remission in acromegaly. Pituitary. 2019; 22(4): 387–396.
