Second line treatment of acromegaly: Pasireotide or Pegvisomant?

Acromegaly is a chronic disease with an increased mortality in case of persistently active disease. The treatment of acromegaly is mainly based on the surgical resection of the GH secreting pituitary tumor and, in cases with persistent disease, on the medical therapy with first generation somatostat...

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Published inBaillière's best practice & research. Clinical endocrinology & metabolism Vol. 36; no. 6; p. 101684
Main Authors Chiloiro, Sabrina, Bianchi, Antonio, Giampietro, Antonella, Pontecorvi, Alfredo, Raverot, Gérald, Marinis, Laura De
Format Journal Article
LanguageEnglish
Published Netherlands Elsevier Ltd 01.12.2022
Elsevier
Subjects
Acromegaly - drug therapy
Adenoma - surgery
Cancer
GH receptor
growth hormone
Human Growth Hormone - therapeutic use
Humans
IGF-I
Insulin-Like Growth Factor I
Life Sciences
Pituitary Neoplasms
Somatostatin - pharmacology
Somatostatin - therapeutic use
somatostatin analogues
somatostatin receptors
Treatment Outcome
GH receptor
IGF-I
somatostatin analogues
growth hormone
somatostatin receptors
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Summary:Acromegaly is a chronic disease with an increased mortality in case of persistently active disease. The treatment of acromegaly is mainly based on the surgical resection of the GH secreting pituitary tumor and, in cases with persistent disease, on the medical therapy with first generation somatostatin analogues (first gen-SSAs). Data from national registries, meta-analysis and epidemiology studies showed that 24%–65% of acromegaly patients treated with first gen-SSA did not reach the control of disease, requiring second line therapies, as the second gen-SSAs and the GH receptor antagonist. According to the high efficacy of these treatments and their molecular mechanisms of action, the choice of second line therapies should be personalized. In this review, we summarize the evidence on clinical, molecular and morphological aspects that may predict the response to second line therapies, in order to integrate and translate in the clinical practice for a patient-tailored therapeutic approach.
ISSN:1521-690X
1878-1594
DOI:10.1016/j.beem.2022.101684