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Open Access 20-08-2022 | Pituitary Adenoma | Original Article

Partial response to first generation SSA guides the choice and predict the outcome of second line therapy in acromegaly

Authors: Sabrina Chiloiro, Denise Costa, Rosa Lauretta, Valeria Mercuri, Emilia Sbardella, Irene Samperi, Marialuisa Appetecchia, Antonio Bianchi, Antonella Giampietro, Patrizia Gargiulo, Andrea M. Isidori, Maurizio Poggi, Alfredo Pontecorvi, Laura De Marinis

Published in: Endocrine | Issue 2/2022

Abstract

Introduction

Treatment of acromegaly resistant to first generation somatostatin analogues (first gen-SSA) is often difficult. We aimed to investigate the role of partial response and resistance to first gen-SSA in the choice of second line treatments and their outcomes.

Patients and methods

A retrospective and multicenter study was conducted on 100 SSA-resistant acromegaly patients and treated with Pasireotide Lar (Pasi-Lar), Peg-V in monotherapy (m-Peg-V) or in combination with first gen-SSA (c-Peg-V).

Results

Thirty-three patients (33%) were treated with m-Peg-V, 36 (36%) with c-Peg-V and 31 with Pasi-Lar (31%). According to logistic regression, m-Peg-V was chosen in older patients (p = 0.01) and with not-invasive adenomas (p = 0.009), c-Peg-V therapy in younger patients (p = 0.001), with invasive adenomas (p = 0.02), Pasi-Lar was in invasive adenomas (p = 0.01) and in patients partially responsive to first-gen SSA (p = 0.01). At the last follow-up, 68 patients (68%) reached the acromegaly control: 22 with m-Peg-V (32.4%), 23 with c-Peg-V (33.8%) and 23 with Pasi-Lar (33.8%). Patients non-responsive to c-Peg-V had higher IGF-I levels (median 3.2 x ULN, IQR: 1.6, p < 0.001) and required higher Peg-V dosage (median 30 mg/daily IQR: 10, p = 0.002) as compared to responsive patients (median IGF-I x ULN: 2.1 IQR: 1.4; median Peg-V dosage 20 mg/daily IQR: 10). All patients responsive to Pasi-Lar were partially responsive to first gen-SSAs (p = 0.02).

Conclusion

Our data showed that c-Peg-V and Pasi-Lar are chosen for the treatment of invasive tumors. The partial response to first gen-SSA seems to be the main determinant for the choice of Pasi-Lar and positively predicts the treatment outcome.

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Title: Partial response to first generation SSA guides the choice and predict the outcome of second line therapy in acromegaly
Authors: Sabrina Chiloiro
Denise Costa
Rosa Lauretta
Valeria Mercuri
Emilia Sbardella
Irene Samperi
Marialuisa Appetecchia
Antonio Bianchi
Antonella Giampietro
Patrizia Gargiulo
Andrea M. Isidori
Maurizio Poggi
Alfredo Pontecorvi
Laura De Marinis
Publication date: 20-08-2022
Publisher: Springer US
Keywords: Pituitary Adenoma
Acromegaly
Published in: Endocrine / Issue 2/2022
Print ISSN: 1355-008X
Electronic ISSN: 1559-0100
DOI: https://doi.org/10.1007/s12020-022-03158-w

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