ECE2018 Poster Presentations: Pituitary and Neuroendocrinology Pituitary - Clinical (101 abstracts)
Efficacy of pasireotide lar in first line somatostatin analogue resistant acromegaly patients: experience from a large and single centre Italian cohort
Sabrina Chiloiro 1 , Antonella Giampietro 1 , Antonio Bianchi 1 , Tommaso Tartaglione 2 , Chiara Bima 1 , Serena Piacentini 1 , Federica Mirra 1 , Federico Donfrancesco 1 , Liverana Lauretti 3 , Carmelo Anile 3 , Alfredo Pontecorvi 1 & Laura De Marinis 1
1Pituitary Unit, Catholic University of the Sacred Heart, Rome, Italy; 2Institute of Radiology, Catholic University of the Sacred Heart, Rome, Italy; 3Department of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy.
Introduction: Pasireotide Lar is a new generation long-acting somatostatin multireceptor ligand, approved for the treatment of first line somatostatin analogue resistant patients. We aimed to review Pasireotide Lar efficacy data, in our series of patients affected by aggressive acromegaly.
Patients: A retrospective longitudinal study was conducted on patients with aggressive acromegaly, resistant to first-line somatostatin analogues (SSA) and on treatment with Pasireotide Lar for at least 6 months. Clinical and radiological data at baseline (Pasireotide Lar start) and at follow-up were collected.
Results: Thirty-one patients met the inclusion criteria. 21 patients were treated with Pasireotide Lar during CSOM230C2304 clinical trial, 3 patients started treatment as for compassionate use and 7 patients started treatment after Pasireotide Lar marketing. 20 patients were female. Mean age at Pasireotide Lar start was 42 years (SD:11.6). All patients were considered affected by active acromegaly at Pasireotide Lar treatment start (mean GH:24.5 ng/mL SD: 46.7; mean IGF-I: 3.58 xUNL SD:1.77). All patients had undergone previous pituitary neurosurgery for macroadenoma and at baseline carried residual disease with cavernous sinus invasion. Ki67 was higher than 1.5% in all patients (mean:2.5 SD:1.7). Types IIa and V Somatostatin analogues receptors (SSTRs) immunohistochemical study was available in 11 patients. Particularly we found a high (score 3) immunoistochemical expression of type V STTR in 2 patients, a mild SSTR5 (score 2) in 5 patients. With regard to SSTR2A, we found a high expression (score 3) in 3 patients and a mild expression (score 2) in 3 patients. In the remaining cases, both SSTR5 and SSTR2A expression was considered negative. Mean duration of Pasireotide Lar treatment was 173.6 months (SD: 650). 24 patients were treated with Pasireotide Lar 60 mg monthly and the remaining 7 patients with Pasireotide Lar 40 mg monthly. Among patients enrolled in CSOM230C2402 study, 14 cases reached the biochemical control of acromegaly. Among patients on post-marketing treatment with Pasireotide Lar, 4 patients were on combination therapy with Pasireotide Lar, Pegvisomant and Dopamine Agonist. At the last examination, 20 patients were on treatment with Pasireotide Lar: 10 patients who had started therapy during CSOM230C2402 clinical trial and all the patients started Pasireotide Lar as compassionate use or post-marketing. All 20 patients documented normalization of GH and IGF-I secretion. In a single case, at neuroradiological follow-up, volumetric reduction of residual pituitary adenoma occurred.
Conclusion: Our data confirmed the efficacy of Pasireotide Lar in aggressive acromegaly.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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