title: Primary treatment of acromegaly with high-dose lanreotide: a case series.
abstract: BACKGROUND
  The first-line treatment for acromegaly is transsphenoidal surgery. In approximately 50% of patients, however, a cure is not possible with surgery and alternatives are needed. Somatostatin analog therapy is the recommended first-line treatment in patients with such cases. Here we provide the first report of a high-dose lanreotide primary therapy in patients with acromegaly.
  
  
  METHODS
  Six patients who were not suitable for surgery were given 60 mg of lanreotide (Autogel(R)) every four weeks. All patients were German nationals and Caucasian.When the response of our patients was unsatisfactory, the dose was increased sequentially to 90 mg every four weeks, 120 mg every four weeks, 120 mg every three weeks and 180 mg every three weeks. Treatment duration was 12 to 24 months. In all cases, the lanreotide dose was 120 mg every 4 weeks or higher. In five of our patients, growth hormone (GH) levels were successfully reduced (in three patients GH <2.5 ng/ml was achieved). Insulin-like growth factor 1 levels were normalized in three patients and decreased in two patients. One patient failed to show a biochemical response to lanreotide therapy or pegvisomant therapy.Tumor shrinkage or degeneration was observed in the five responding patients. No drug-related adverse events were noted.
  
  
  CONCLUSIONS
  These results suggest that lanreotide at high doses of 120 mg every four weeks or more is an effective first-line therapy for patients with acromegaly that surgery alone cannot treat.
authors.affiliation: Clinic for Endocrinology, Bahnhofplatz 2, D-55116 Mainz, Germany. wuester@endokrinologie-mainz.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Wuster
authors.forename: Stefan
authors.initials: S
authors.lastname: Both
authors.forename: Uwe
authors.initials: U
authors.lastname: Cordes
authors.forename: Wael
authors.initials: W
authors.lastname: Omran
authors.forename: Robert
authors.initials: R
authors.lastname: Reisch