ECE2023 Eposter Presentations Pituitary and Neuroendocrinology (234 abstracts)
Precision medicine in acromegaly: results of the ACROFAST study
Manel Puig-Domingo 1,2 , Montserrat Marques-Pamies 3 , Joan Gil 4 , Elena Valassi 5,6 , Olga Giménez-Palop 7 , Marta Hernandez 8,9 , Rocio Villar Taibo 10 , Betina Biagetti 11 , Gemma Xifra Villarroya 12 , Andreu Simó-Servat 13 , Roxana Zavala 14 , Inmaculada Simón 14 , Marta Araujo-Castro 15 , Rogelio García Centeno 16 , María Calatayud 17 , Federico Vazquez San Miguel 1 , N Vilarrasa 18,19 , Isabel Salinas Vert 1 , Mireia Mora 20,21 , Felicia Alexandra Hanzu 20,21 , Maria Paz De Miguel Novoa 22 , Isabel Pavon 23 , Concepción Blanco 24 , Cristina Alvarez-Escola 25 , Miguel Antonio Sampedro-Nuñez 26 , Mireia Jorda 27 , Ignacio Bernabeu 10 , Susan Webb 28 & Monica Marazuela 29
1Germans Trias i Pujol University Hospital, Endocrinology and Nutrition, Badalona, Spain; 2Germans Trias i Pujol Institute (IGTP), Badalona, Spain; 3Hospital Municipal de Badalona, Endocrinology and Nutricion, Badalona, Spain; 4Germans Trias i Pujol Institue (IGTP), Endocrine Research Unit, Badalona, Spain; 5Germans Trias i Pujol Unviersity Hospital, Endocrinology and Nutrition, Badalona, Spain; 6Germans Trias i Pujol Insititute (IGTP), Badalona, Spain; 7Parc Taulí de Sabadell University Hospital, Endocrinology and Nutrition, Sabadell, Spain; 8Arnau de Vilanova University Hospital, Endocrinology and Nutrition, Lleida, Spain; 9Institut de Recerca Biomèdica de Lleida Fundació Dr. Pifarré, Lleida, Spain; 10Santiago Clinic Hospital CHUS, Endocrinology and Nutrition, Santiago de Compostela, Spain; 11Vall d’Hebron University Hospital, Endocrinology and Nutrition, Barcelona, Spain; 12Doctor Josep Trueta University Hospital, Endocrinology and Nutrition, Girona, Spain; 13MútuaTerrassa University Hospital, Endocrinology and Nutrition, Terrassa, Spain; 14Joan XXIII Tarragona University Hospital, Endocrinology and Nutrition, Tarragona, Spain; 15Ramón y Cajal University Hospital, Endocrinology and Nutrition, Madrid, Spain; 16Gregorio Marañón General University Hospital, Endocrinology and Nutrition, Madrid, Spain; 17University Hospital October 12, Endocrinology and Nutrition, Madrid, Spain; 18Bellvitge University Hospital, Endocrinology and Nutrition, L’Hospitalet de Llobregat, Spain; 19IDIBELL Institut d’Investigació Biomèdica de Bellvitge, L’Hospitalet de Llobregat, Spain; 20Hospital Clínic de Barcelona, Endocrinology and Nutrition, Barcelona, Spain; 21Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; 22Hospital Clinico Universitario San Carlos, Endocrinology and Nutrition, Madrid, Spain; 23Getafe University Hospital, Endocrinology and Nutrition, Getafe, Spain; 24Príncipe de Asturias University Hospital, Endocrinology and Nutrition, Alcalá de Henares, Spain; 25La Paz University Hospital, Endocrinology and Nutrition, Madrid, Spain; 26La Princesa University Hospital, Endocrinology and Nutrition, Madrid, Spain; 27Germans Trias i Pujol Institute (IGTP), Endocrine Research Unit, Badalona, Spain; 28Santa Creu i Sant Pau University Hospital, Endocrinology and Nutrition, Barcelona, Spain; 29La Princesa Unviersity Hospital, Endocrinology and Nutrition, Madrid, Spain
Medical treatment of acromegaly is currently performed through a trial-error manner using somatostatin receptor ligands (SRLs) as first-line drugs. Average SRLs response is seen in 50% of cases; subsequent drugs are indicated following clinical judgement. Some biomarkers either before or after surgical failure have been reported to predict SRLs response, including intensity in T2 weighted MRI, short acute octreotide test (sAOT), and different molecules such as SST2 and E-cadherin. We report the preliminary data of the ACROFAST study, a prospective trial based on the assignation of medical treatment according to SRLs response biomarkers compared to a control group.
Methods and subjects: Prospective clinical academic trial in which 21 university hospitals participated. Two protocols were compared in which the outcomes were time to control and percentage of subjects controlled at 6 and 12 months of treatment: A) a sequential protocol in which SRLs were started at mild doses (octreotide 20 mg and lanreotide 90 mg) for all patients and B) a personalized protocol in which SRLs were given as monotherapy (B1), in combination with pegvisomant (B2) or were replaced for pegvisomant as monotherapy (B3) according T2 MRI signal and sAOT in presurgical cases and the E-cadherin immunoexpression in tumor tissue in case of active disease after surgical treatment. B1 option included patients in which T2 MRI showed an hypointense signal, a GH at 2 h <2.7 ng/ml in the sAOT or had a full + immunostaining for E-cadherin. B3 option included cases in which MRI presented an hyperintense signal and sAOT GH decrease <50% over basal and in postsurgical failures, those – for E-cadherin; B2 were considered partial responders, in which sAOT showed a GH value at 2 h >2.7 ng/ml and >50% over basal together with an hypointense T2 MRI image, and in postsurgical intermediate positivity for E-cadherine.
Results: By December 2022, 73 patients have been recruited and 53 were evaluable, 27 in the personalized arm and 30 in the control sequential group. More patients in the personalized protocol 19/27 (70%) had achieved hormonal control compared to those in the sequential group – 14/30 (43%), P<0.03)- as well as in a shorter period of time: 263 days -8.8 months- vs 360 days -12 months- (P<0.009) for partial and resistant cases.
Conclusion: Personalized medicine is feasible by using a relatively simple protocol and allows a higher number of patients under control in less time since treatment initiation.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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