Pasireotide in the Personalized Treatment of Acromegaly
Puig Domingo, Manuel (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Bernabeu Morón, Ignacio (Endocrinology & Nutrition Service, Complejo Universitario de Santiago de Compostela)
Picó Alfonso, Antonio M (Hospital General Universitario de Alicante (Alacant, País Valencià))
Biagetti, Betina (Hospital Universitari Vall d'Hebron)
Gil, Joan (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Álvarez-Escolá, Cristina (Hospital Universitario La Paz (Madrid))
Jordà, Mireia (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Marques-Pamies, Montserrat (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Soldevila i Madorell, Berta (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Gálvez, María-Angeles (Hospital Universitario Reina Sofía (Còrdova, Espanya))
Cámara, Rosa (Hospital Universitari i Politècnic La Fe (València))
Aller, Javier (Hospital Universitario Puerta de Hierro Majadahonda (Madrid))
Lamas, Cristina (Complejo Hospitalario Universitario de Albacete)
Marazuela, Mónica (Hospital Universitario de la Princesa (Madrid))
Universitat Autònoma de Barcelona

Data:	2021
Resum:	The delay in controlling the disease in patients who do not respond to first-line treatment with first generation somatostatin receptor ligands (first-generation SRLs) can be quantified in years, as every modification in the medical therapy requires some months to be fully evaluated. Considering this, acromegaly treatment should benefit from personalized medicine therapeutic approach by using biomarkers identifying drug response. Pasireotide has been positioned mostly as a compound to be used in first-generation SRLs resistant patients and after surgical failure, but sufficient data are now available to indicate it is a first line therapy for patients with certain characteristics. Pasireotide has been proved to be useful in patients in which hyperintensity T2 MRI signal is shown and in those depicting low SST2 and high expression of SST5, low or mutated AIP condition and sparsely granulated immunohistochemical pattern. This combination of clinical and pathological characteristics is unique for certain patients and seems to cluster in the same cases, strongly suggesting an etiopathogenic link. Thus, in this paper we propose to include this clinico-pathologic phenotype in the therapeutic algorithm, which would allow us to use as first line medical treatment those compounds with the highest potential for achieving the fastest control of GH hypersecretion as well as a positive effect upon tumor shrinkage, therefore accelerating the implementation of precision medicine for acromegaly. Moreover, we suggest the development, validation and clinical use of a pasireotide acute test, able to identify patients responsive to pasireotide LAR as the acute octreotide test is able to do for SRLs.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Resistance to medical treatment in acromegaly ; Somatostatin analogues ; Somatostatin receptor ligands ; Personalized medicine ; Somatotroph adenoma ; Growth hormone ; PitNETs ; Endocrine tumors
Publicat a:	Frontiers in endocrinology, Vol. 12 (march 2021) , ISSN 1664-2392

DOI: 10.3389/fendo.2021.648411
PMID: 33796079

9 p, 714.0 KB

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