ECE2022 Poster Presentations Pituitary and Neuroendocrinology (127 abstracts)
Pasireotide imaging study: magnetic resonance imaging as a predictor of therapeutic response in acromegaly
Sabina Ruiz 1 , Eva Venegas Moreno 2 , Joan Gil 1 , ROSA CAMARA 3 , Betina Biagetti 4 , Maria Angeles Galvez Moreno 5 , Silvia Maraver 6 , Inmaculada Gonzalez-Molero 7 , Antonio Picó-Alfonso 8 , Pablo Abellán Galiana 9 , pablo trincado 10 , Maria Teresa Herrera Arranz 11 , Pilar Olvera 11 , Gemma Xifra Villarroya 12 , Ignacio Bernabeu 13 , Sharona Azriel Mira 14 , Lourdes García-GarcíA-Doncel 15 , Mireia Jorda 1 , Elena Valassi 1 & Manel Puig-Domingo 1
1Germans Trias i Pujol Hospital, Badalona, Spain; 2Virgen del Rocío University Hospital, Sevilla, Spain; 3La Fe University and Polytechnic Hospital, València, Spain; 4La Vall d’Hebron, Barcelona, Spain; 5Hospital Universitario Reina Sofia, Córdoba, Spain; 6Hospital Universitario Virgen de la Victoria, Málaga, Spain; 7Hospital Regional Universitario de Málaga, Málaga, Spain; 8General University Hospital of Alicantet, Alacant, Spain; 9Hospital General Universitari de Castelló, Castelló de la Plana, Spain; 10Miguel Servet Hospital Outpatients, Zaragoza, Spain; 11Our Lady of Candelaria University Hospital, Santa Cruz de Tenerife, Spain; 12Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain; 13Santiago Clinic Hospital CHUS, Santiago de Compostela, Spain; 14Infanta Sofia University Hospital, San Sebastián de los Reyes, Spain; 15Hospital Universitario De Jerez, Jerez de la Frontera, Spain
Background: T2-weighted magnetic resonance imaging (MRI) signal has been recently linked with a better tumor response to pasireotide treatment in patients with acromegaly (ACRO). Our aim was to evaluate the prevalence of this radiological feature and its association to therapeutic outcomes in a large cohort of ACRO patients treated with pasireotide.
Methods: A retrospective multicentre study was performed in 15 Spanish tertiary university hospitals including patients with active ACRO who have been taking pasireotide as a second-line treatment according to current clinical guidelines. Pituitary tumor T2-weighted MRI signal was classified as “iso-hyperintense” or “hypointense” by local neuro-radiologists. Insulin-like growth factor 1 (IGF-1) levels and tumor volume reduction (≥25% from baseline) were assessed after 6 and 12 months of pasireotide treatment and results analysed according to MRI pre-treatment signal. Response to pasireotide was defined as “complete” when normalization of IGF-I levels was achieved or “partial” when a decreased of ≥50% in IGF-I was obtained. “No response” was defined as <50% decrease in IGF-I from baseline.
Results: Sixty-nine patients were included (50.7% females, age 48.3±13.3), of whom 55 (79.7%) had previously undergone surgery and 63 (92.6%) treatment with first-generation somatostatin analogues, remaining with active disease before initiation of pasireotide. MRI signal was hypointense in 20 (29%) and hyperintense in 49 (71%) of the patients. Hyperintense group showed larger initial tumor compared to hypointense (7900±2000 mm3 vs 679±1500 mm3 P=0.001). Complete response to pasireotide treatment at 6 months was observed in 40 (58.8%), partial response in 1 (1.5%), and no response in 27 (39.7%) patients, while at 12 months, 40 (69%), 1 (1.7%) and 17 (29.3%) were under the aforementioned control categories, respectively, and it was not related to MRI signal category. A ≥25% reduction from basal tumor volume was observed in 18 (43.9%) patients after 12 months of pasireotide treatment, in the hyperintense signal group (15 out of 49 patients) (mean reduction -2064±2638 mm3 P=0.04) while in the hypointense signal group in only 3 patients a decrease ≥25% was observed, while in the rest the tumor volume did not changed or increased. There was no correlation of volume decrease and normalization of IGF-1.
Conclusion: Almost 70% of acromegaly patients who had not responded to first-generation somatostatin analogues showed a complete hormonal response to pasireotide, regardless of the T2-weighted MRI signal, at one year of follow-up. Compared to hypointense, hyperintense T2-weighted MRI signal is associated to a better tumor shrinkage response over time.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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