EP1146 - ECE_2526 - Long-term treatment with first-generation somatostatin receptor ligands in acromegaly: predictors of dose reduction and withdrawal

Le résumé fourni par la source

Abstract Introduction In acromegaly, therapy with first-generation somatostatin receptor ligands (fgSRLs) plays a central role, especially in patients who do not achieve surgical remission. We have observed that long-term use of fgSRLs, may allow, in some patients, a progressive dose reduction and even a complete withdrawal, resulting in sustained disease remission. Patients and Methods A longitudinal, retrospective, observational study was performed on patients with acromegaly in therapy with fg-SRLs, with a 15 years follow-up. Dose reduction and withdrawal were correlated with gender, age at diagnosis, GH and IGF-I levels at diagnosis and after surgery, biochemical control, adenoma's size and its intensity on MRI, and finally, histopathological characteristics. Results Dose reduction and withdrawal was achieved in 9 patients out of 34 patients treated with fg-SRLs at our institution with a 15 years follow-up. In this group of patients, fg-SRL dose reduction and withdrawal did not differ among patient gender (P = .5), age at acromegaly diagnosis (P = .204), GH and IGF-I levels at diagnosis, after surgery and with the achievement of biochemical control at 6 and 12 months of treatment with conventional dose of fg-SRLs (P = .64 and P = .46). All patients with microGH secreting pituitary adenoma underwent fg-SRL dose reduction/withdrawal (P < .003), without difference in invasive and not-invasive macroadenoma (P = .124). Fg-SRL dose reduction/withdrawal was achieved more frequently in hypointense tumors in T2-weighted MRI sequencies (P = .028). The proliferative index, cytokeratin pattern and SSTR2A expression did not differ among patients underwent and not-underwent fg-SRL dose reduction/withdrawal. Treatment with high frequency fg-SRLs administrations did not correlate with the fg-SRL dose reduction/withdrawal (P = .581). Discussion Our study shows that the probability of reducing or withdrawing therapy with fgSRLs depends on tumor characteristics, particularly size and MRI intensity. These results support prognostic stratification of patients and, most importantly, underline the importance of a personalized therapeutic approach.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.