First‐line octreotide‐LAR therapy induces tumour shrinkage and controls hormone excess in patients with acromegaly: results from an open, prospective, multicentre trial

Colao, Annamaria; Pivonello, Rosario; Rosato, F.; Tita, Patrizia; Menis, Ernesto De; Barreca, Antonina; Ferrara, Roberto; Mainini, F; Arosio, Maura; Lombardi, Gaetano

doi:10.1111/j.1365-2265.2006.02467.x

Cited by 71 publications

(41 citation statements)

References 34 publications

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“…Several papers in recent years report the efficacy of primary pharmacotherapy in achieving biochemical disease control. Similar rates of patient control were achieved in the primary and adjuvant groups, with GH plasma levels ≤2.5 μg/L (64%) and/or normalization of IGF-1 (64%) Ayuk et al, 2002Ayuk et al, , 2004Bevan et al, 2002;Colao et al, 2001Colao et al, , 2006cCozzi et al, 2003Cozzi et al, , 2006. Even though de novo patients had higher pre-treatment GH or IGF-1 levels or both, than those already treated with surgery and/or radiotherapy, patients achieved the same ultimate level of biochemical control by the end of the study Cozzi et al, 2003).…”

Section: Biochemical Controlmentioning

confidence: 54%

Somatostatin agonists for treatment of acromegaly

Ben-Shlomo

Melmed

2008

Molecular and Cellular Endocrinology

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The discovery of somatotropin-release inhibitory factor (SRIF) in hypothalamic extract in 1970 led to the synthesis of the first somatostatin analog octreotide, discovery of five somatostatin receptor subtypes, and development of additional somatostatin receptor ligands (SRL) as pharmacotherapy for acromegaly and other neuroendocrine tumors. Long-acting formulations of SRL (octreotide LAR Depot, lanreotide SR and lanreotide autogel) assure improved patient compliance with weekly up to monthly injections, and are commonly used as primary or adjuvant treatment of acromegaly. We review SRL currently available, emphasizing long-acting compounds and their efficacy in controlling acromegaly. Disease control is evaluated by biochemical markers, tumor shrinkage, and diseasesymptom improvement balanced against drug-related side effects.

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Section: Biochemical Controlmentioning

confidence: 54%

Somatostatin agonists for treatment of acromegaly

Ben-Shlomo

Melmed

2008

Molecular and Cellular Endocrinology

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“…Surgical outcome was found to be better in patients with microadenomas of various types as compared with macroadenomas of these types (30)(31)(32). Primary medical treatment of GH-secreting pituitary adenomas with somatostatin analogs was more efficacious in microadenomas compared with macroadenomas (33). Generally, larger tumors recur more frequently than smaller adenomas after surgery.…”

Section: Tumor Size As a Marker Of Pituitary Adenomasmentioning

confidence: 81%

Pathohistological classification of pituitary tumors: 10 years of experience with the German Pituitary Tumor Registry

Saeger

Lüdecke²,

Buchfelder³

et al. 2007

eur j endocrinol

531

346

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In 1996, the German Registry of Pituitary Tumors was founded by the Pituitary Section of the German Society of Endocrinology as a reference center for collection and consultant pathohistological studies of pituitary tumors. The experiences of the first 10 years of this registry based on 4122 cases will herein be reported. The data supplement former collections of the years 1970-1995 with 3480 surgically removed tumors or lesions of the pituitary region. The cases were studied using histology, immunostainings and in some cases also molecular pathology or electron microscopy. The adenomas were classified according to the current World Health Organization classification in the version of 2004. From 1996 on 3489 adenomas (84.6%), 5 pituitary carcinomas (0.12%), 133 craniopharyngiomas (3.2%), 39 meningiomas (0.94%), 25 metastases (0.6%), 22 chordomas (0.5%), 115 cystic non-neoplastic lesions (2.8%), and 46 inflammatory lesions (1.1%, 248 other lesions or normal tissue (6.0%)) were collected by us. The adenomas (100%) were classified into densely granulated GH cell adenomas (9.2%), sparsely granulated GH cell adenomas (6.3%), sparsely granulated prolactin (PRL) cell adenomas (8.9%), densely granulated PRL cell adenomas (0.3%), mixed GH/PRL cell adenomas (5.2%), mammosomatotropic adenomas (1.1%), acidophilic stem cell adenomas (0.2%), densely granulated ACTH cell adenomas (7.2%), sparsely granulated ACTH cell adenomas (7.9%), Crooke cell adenomas (0.03%), TSH cell adenomas (1.5%), FSH/LH cell adenomas (24.8%), null cell adenomas (19.3%), null cell adenoma, oncocytic variant (5.8%), and plurihormonal adenomas (1.3%).

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“…HOMA-R and HOMA-b were significantly reduced during treatment Figure 2 Percent suppression of GH (top) and IGF-I levels (bottom) in the Groups A, B, and C from baseline to 12 months of treatment (12), from 12 to 24 months of treatment (24) and total suppression (from baseline to 24 months of treatment). *P!0.01 vs 12 months Groups A and B; **P!0.01 vs 12 months suppression in individual groups; ***P!0.05 vs 24 months Groups A and B; ****P!0.05 vs 12 months Group A; *****P!0.05 vs 12 months Group B. independently from the dose of Octreotide-LAR used (Table 2) and disease control (data not shown).…”

Section: Secondary Outcome Measuresmentioning

confidence: 99%

“…2. Tumor volume on MRI studies performed on clinical 1T and 1.5T scanners using T1-weighted gradient recalled-echo in the sagittal and the coronal planes, as already reported (6,9,12). The acquisitions were repeated before and after the (6,9) on post-treatment MRI, tumor shrinkage was assessed as the percent decrease of tumor volume when compared with baseline.…”

Section: Study Protocolmentioning

confidence: 99%

Beneficial effect of dose escalation of Octreotide-LAR as first-line therapy in patients with acromegaly

Colao

Pivonello

Auriemma

et al. 2007

European Journal of Endocrinology

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Objective: To evaluate the efficacy of dose escalation of Octreotide-long-acting repeatable (LAR) up to 40 mg/month we studied 56 newly diagnosed patients with acromegaly (24 women, 32 men; age 20-82 years). Design: Analytical, observational, open and prospective. Methods: Three months after LAR treatment beginning with a dose of 20 mg /q28d (every 28 days), 24 patients maintained the same dose (Group A), while 32 required a dose of 30 mg/q28d (Group B). The dose was further increased to 40 mg/q28d in 17 out of the 32 patients of Group B for another 12 months (Group C). Results: After 24 months, serum GH and IGF-I levels decreased by 93.1G8.6% (95% confidence limit (CL) 90.8-95.4%) and 62.7G13.4% (95% CL 59.1-66.3%) respectively. Control of GH and IGF-I levels was achieved in 45 patients (80.3%). Tumor shrinkage after 12 months was 49.8G23%; the relative tumor shrinkage during the second 12 months of treatment was 35.3G13.1% and overall tumor volume was 68.1G16.5% (95% CL 63.7-72.5%). Glucose tolerance impaired in eight patients (14.3%): four in Group A and four in Group C (16.7% vs 36.4%, PZ0.39).The final dose was predicted by the patient's age at diagnosis (tZK2.2; PZ0.032) and baseline tumor volume (tZ2.1; PZ0.043). Conclusion: An increase of the LAR dose up to 40 mg/q28d in patients resistant to 30 mg/q28d is followed by greater suppression of GH and IGF-I levels and tumor shrinkage without further significant impairment of glucose tolerance when compared with lower doses. These results suggest that a new dosage schedule of 40 mg every 28 days is applied in patients with acromegaly mostly of young age and with bigger tumors who are likely to be poorly responsive to standard doses of Octreotide-LAR.

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First‐line octreotide‐LAR therapy induces tumour shrinkage and controls hormone excess in patients with acromegaly: results from an open, prospective, multicentre trial

Cited by 71 publications

References 34 publications

Somatostatin agonists for treatment of acromegaly

Somatostatin agonists for treatment of acromegaly

Pathohistological classification of pituitary tumors: 10 years of experience with the German Pituitary Tumor Registry

Beneficial effect of dose escalation of Octreotide-LAR as first-line therapy in patients with acromegaly

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