title: Efficacy of combined octreotide and cabergoline treatment in patients with acromegaly: a retrospective clinical study and review of the literature.
abstract: Although somatostatin analogues are effective medical therapy for acromegaly, the serum insulin-like growth factor-I (IGF-I) levels remain uncontrolled in 35% of patients. Combined therapy with octreotide LAR and cabergoline has been reported to normalize IGF-I levels in 42-56% of Caucasian patients with acromegaly. However, it remains to be clarified whether combination therapy is effective in Japanese patients and on tumor shrinkage. We conducted a retrospective study on combined therapy in patients with octreotide-resistant acromegaly. Ten patients with acromegaly who showed octreotide-resistance were enrolled in this study. Cabergoline was added in doses of 0.25-2.0mg/week. Serum GH and IGF-I levels and tumor volume were assessed before and after treatment, and factors correlated with effect of the combined therapy were analyzed. Although serum GH levels did not decrease, serum IGF-I levels significantly decreased by 20% after 6 months of combined therapy compared with baseline (p < 0.05). As a result, serum IGF-I levels normalized in 30% of the patients. Tumor volume after combined therapy also significantly decreased (p < 0.01). There were no correlations between the decrease of serum IGF-I levels during combined therapy and the response of GH in a bromocriptine test, random GH, IGF-I, and PRL levels, the tumor volume, and the expression of PRL and dopamine D2 receptor in the tumor. In conclusion, we demonstrated that the addition of cabergoline to octreotide LAR is a beneficial option in Japanese patients with octreotide-resistant acromegaly, irrespective of serum PRL levels and the response of GH levels in a bromocriptine test.
authors.affiliation: Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Suda
authors.forename: Naoko
authors.initials: N
authors.lastname: Inoshita
authors.forename: Genzo
authors.initials: G
authors.lastname: Iguchi
authors.forename: Hidenori
authors.initials: H
authors.lastname: Fukuoka
authors.forename: Michiko
authors.initials: M
authors.lastname: Takahashi
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Nishizawa
authors.forename: Masaaki
authors.initials: M
authors.lastname: Yamamoto
authors.forename: Shozo
authors.initials: S
authors.lastname: Yamada
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Takahashi
mesh_terms: D000172:Acromegaly / Q000209:etiology / Q000517:prevention & control*; D000236:Adenoma / Q000097:blood / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D000077465:Cabergoline; D003692:Delayed-Action Preparations / Q000627:therapeutic use; D004351:Drug Resistance; D004873:Ergolines / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000097:blood / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D007564:Japan; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000008:administration & dosage / Q000627:therapeutic use*; D010902:Pituitary Gland / Q000187:drug effects* / Q000473:pathology; D012189:Retrospective Studies; D013004:Somatostatin / Q000031:analogs & derivatives; D047368:Tumor Burden / Q000187:drug effects; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D003692:Delayed-Action Preparations; D004873:Ergolines; C583557:IGF1 protein, human; D013004:Somatostatin; D007334:Insulin-Like Growth Factor I; D000077465:Cabergoline; D015282:Octreotide