Pasireotide in the Personalized Treatment of Acromegaly
Por:
Puig-Domingo, M, Bernabeu, I, Pico, A, Biagetti, B, Gil, J, Alvarez-Escola, C, Jorda, M, Marques-Pamies, M, Soldevila, B, Galvez, MA, Camara, R, Aller, J, Lamas, C and Marazuela, M
Publicada:
16 mar 2021
Ahead of Print:
16 mar 2021
Resumen:
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.
Filiaciones:
:
Autonomous Univ Barcelona, Germans Trias Hosp & Res Inst, Endocrinol & Nutr Serv, Badalona, Spain
Bernabeu, I:
Complejo Univ Santiago de Compostela, Endocrinol & Nutr Serv, Santiago De Compostela, Spain
Pico, A:
Univ Hosp, Endocrinol & Nutr Serv, Alicante, Spain
Biagetti, B:
Vall d'Hebron Univ Hosp, Endocrinol & Nutr Serv, Barcelona, Spain
:
Autonomous Univ Barcelona, Germans Trias Hosp & Res Inst, Endocrinol & Nutr Serv, Badalona, Spain
Alvarez-Escola, C:
La Paz Hosp, Endocrinol & Nutr Serv, Madrid, Spain
:
Autonomous Univ Barcelona, Germans Trias Hosp & Res Inst, Endocrinol & Nutr Serv, Badalona, Spain
Marques-Pamies, M:
Autonomous Univ Barcelona, Germans Trias Hosp & Res Inst, Endocrinol & Nutr Serv, Badalona, Spain
:
Autonomous Univ Barcelona, Germans Trias Hosp & Res Inst, Endocrinol & Nutr Serv, Badalona, Spain
Galvez, MA:
Reina Sofia Univ Hosp, Endocrinol & Nutr Serv, Cordoba, Spain
Camara, R:
La Univ Hosp, Endocrinol & Nutr Serv, Valencia, Spain
Aller, J:
Puerta Hierro Univ Hosp, Endocrinol & Nutr Serv, Majadahonda, Spain
Lamas, C:
Complejo Hosp Univ Albacete, Endocrinol & Nutr Serv, Albacete, Spain
Marazuela, M:
La Princesa Univ Hosp, Endocrinol & Nutr Serv, Madrid, Spain
gold, Green Published
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