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Review
. 2021 Mar 16:12:648411.
doi: 10.3389/fendo.2021.648411. eCollection 2021.

Pasireotide in the Personalized Treatment of Acromegaly

Manel Puig-Domingo  1 , Ignacio Bernabéu  2 , Antonio Picó  3 , Betina Biagetti  4 , Joan Gil  1 , Cristina Alvarez-Escolá  5 , Mireia Jordà  1 , Montserrat Marques-Pamies  1 , Berta Soldevila  1 , María-Angeles Gálvez  6 , Rosa Cámara  7 , Javier Aller  8 , Cristina Lamas  9 , Mónica Marazuela  10
Affiliations
Review

Pasireotide in the Personalized Treatment of Acromegaly

Manel Puig-Domingo et al. Front Endocrinol (Lausanne). .

Abstract

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.

Keywords: PitNETs; endocrine tumors; growth hormone; personalized medicine; resistance to medical treatment in acromegaly; somatostatin analogues; somatostatin receptor ligands; somatotroph adenoma.

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Conflict of interest statement

MP-D, IB, CA-E, AP, M-AG, RC, BB, JA, CL, and MM received grants support and participated in speaker bureau for Pfizer, Recordati, Ipsen, and Novartis. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Therapeutic algorithm for medical treatment of acromegaly before surgery.
Figure 2
Figure 2
Therapeutic algorithm for medical treatment of acromegaly after non-curable surgery.
See this image and copyright information in PMC

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