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Partial response to first generation SSA guides the choice and predict the outcome of second line therapy in acromegaly
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 retr...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer US
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9584996/ https://www.ncbi.nlm.nih.gov/pubmed/35986839 http://dx.doi.org/10.1007/s12020-022-03158-w |
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author | Chiloiro, Sabrina Costa, Denise Lauretta, Rosa Mercuri, Valeria Sbardella, Emilia Samperi, Irene Appetecchia, Marialuisa Bianchi, Antonio Giampietro, Antonella Gargiulo, Patrizia Isidori, Andrea M. Poggi, Maurizio Pontecorvi, Alfredo De Marinis, Laura |
author_facet | Chiloiro, Sabrina Costa, Denise Lauretta, Rosa Mercuri, Valeria Sbardella, Emilia Samperi, Irene Appetecchia, Marialuisa Bianchi, Antonio Giampietro, Antonella Gargiulo, Patrizia Isidori, Andrea M. Poggi, Maurizio Pontecorvi, Alfredo De Marinis, Laura |
author_sort | Chiloiro, Sabrina |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-9584996 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Springer US |
record_format | MEDLINE/PubMed |
spelling | pubmed-95849962022-10-22 Partial response to first generation SSA guides the choice and predict the outcome of second line therapy in acromegaly Chiloiro, Sabrina Costa, Denise Lauretta, Rosa Mercuri, Valeria Sbardella, Emilia Samperi, Irene Appetecchia, Marialuisa Bianchi, Antonio Giampietro, Antonella Gargiulo, Patrizia Isidori, Andrea M. Poggi, Maurizio Pontecorvi, Alfredo De Marinis, Laura Endocrine Original Article 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. Springer US 2022-08-20 2022 /pmc/articles/PMC9584996/ /pubmed/35986839 http://dx.doi.org/10.1007/s12020-022-03158-w Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Original Article Chiloiro, Sabrina Costa, Denise Lauretta, Rosa Mercuri, Valeria Sbardella, Emilia Samperi, Irene Appetecchia, Marialuisa Bianchi, Antonio Giampietro, Antonella Gargiulo, Patrizia Isidori, Andrea M. Poggi, Maurizio Pontecorvi, Alfredo De Marinis, Laura Partial response to first generation SSA guides the choice and predict the outcome of second line therapy in acromegaly |
title | Partial response to first generation SSA guides the choice and predict the outcome of second line therapy in acromegaly |
title_full | Partial response to first generation SSA guides the choice and predict the outcome of second line therapy in acromegaly |
title_fullStr | Partial response to first generation SSA guides the choice and predict the outcome of second line therapy in acromegaly |
title_full_unstemmed | Partial response to first generation SSA guides the choice and predict the outcome of second line therapy in acromegaly |
title_short | Partial response to first generation SSA guides the choice and predict the outcome of second line therapy in acromegaly |
title_sort | partial response to first generation ssa guides the choice and predict the outcome of second line therapy in acromegaly |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9584996/ https://www.ncbi.nlm.nih.gov/pubmed/35986839 http://dx.doi.org/10.1007/s12020-022-03158-w |
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