Primary treatment of acromegaly with high-dose lanreotide: a case series

Abstract

Introduction: 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.

Case presentation: 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.

Figure 1

Insulin-like growth factor 1 values in Case 1 during lanreotide treatment for one year. Baseline value is pre-treatment value. Lanreotide dose increased from 60 mg to 120 mg every four weeks after one month and to 180 mg every three weeks after 10 months. Upper limit of normal is 483 ng/ml.

Figure 2

(A) Magnetic resonance imaging scan showing the tumor size before lanreotide treatment. (B) Magnetic resonance imaging scan showing a reduction in tumor size after 10 months of lanreotide treatment in Case 1.