First-line octreotide-LAR therapy induces tumour shrinkage and controls hormone excess in patients with acromegaly: results from an open, prospective, multicentre trial.
BACKGROUND
The majority of patients with acromegaly have large tumours and the outcome of conventional management remains poor.


OBJECTIVE
To investigate the clinical application of octreotide-LAR as primary treatment in newly diagnosed patients with GH-secreting pituitary tumours.


METHODS
Open, prospective, multicentre, 24-week follow-up study.


METHODS
Thirty-four patients were enrolled (20 men, 14 women; mean age, 50 years); 13 had microadenoma [median tumour volume 327 mm(3) (range 31-629 mm(3))], 21 had macroadenoma [median tumour volume 1,325 mm(3) (range 503-11,583 mm(3))]. Interventions Octreotide-LAR at the dosage of 20 mg every 28 days for the first 12 weeks increased to 30 mg every 28 days to control GH and/or IGF-I excess in 20 patients (64.7%).


METHODS
Primary endpoints were control of GH (fasting < 2.5 microg/l) and IGF-I secretion (gender- and age-normalized) and presence and entity of tumour mass shrinkage. Secondary endpoint was improvement of symptoms score.


RESULTS
In patients with micro- and macroadenomas GH levels decreased to < 2.5 microg/l in 84.6% and 45%, serum IGF-I levels normalized for age and gender in 61.5% and 35% of cases. Failure in achieving either GH < 2.5 microg/l or normal IGF-I levels was found in none of the patients with micro- and in 45% of patients with macroadenoma. Median tumour volume was reduced by 54% (range: -90% to +350%) in micro- and by 49% (range -94% to -14%) in macroadenomas. Headache, perspiration and osteo-arthralgias disappeared in 21%, paresthesias in 38%, fatigue in 26% and carpal tunnel syndrome in 15%. The treatment was well tolerated: more frequent adverse events were gastrointestinal (in 44%).


CONCLUSIONS
In both patients with micro- or macroadenoma, primary octreotide-LAR treatment controls hormone excess, induces tumour shrinkage and improves symptoms of acromegaly with limited side effects and can be therefore successfully employed in patients with contraindications for surgery or in those who refuse surgery.
Department of Molecular and Clinical Endocrinology and Oncology, Federico II, University of Naples, Italy. colao@unina.it
Annamaria
A
Colao
Rosario
R
Pivonello
Francesca
F
Rosato
Patrizia
P
Tita
Ernesto
E
De Menis
Antonina
A
Barreca
Roberto
R
Ferrara
Franco
F
Mainini
Maura
M
Arosio
Gaetano
G
Lombardi
D000172:Acromegaly / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D000236:Adenoma / Q000150:complications / Q000188:drug therapy / Q000473:pathology; D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D003692:Delayed-Action Preparations; D005260:Female; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D019382:Human Growth Hormone / Q000097:blood; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D016896:Treatment Outcome
D018931:Antineoplastic Agents, Hormonal; D003692:Delayed-Action Preparations; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I; D015282:Octreotide