Long-term pasireotide-LAR treatment in the personalized therapy of patients with complex acromegaly: a collection of clinical experiences

Abstract

Pasireotide-LAR is recommended as a second-line treatment for patients with acromegaly. Although the effects of pasireotide-LAR have been well characterized in clinical studies, real-practice evidence is scant, especially in the long term and within the individualization of therapy in patients with comorbidities. To provide additional insight on the individualized approach to acromegaly management, six clinical cases of complex acromegaly treated with pasireotide-LAR for more than 5 years were reported. Pasireotide-LAR allowed the normalization of insulin-like growth factor 1 (IGF1) values in all patients and reduced tumour residue volume where present. A good safety profile and long-term tolerability were also reported.

Keywords: IGF1; acromegaly; diabetes mellitus; growth hormone; pasireotide-LAR; somatotropinoma.

Figure 1

Post-contrast coronal T1 MRI shows pituitary mass in the right and inferior portion of the pituitary with lateral extension into the cavernous sinus before starting pasireotide-LAR (A, arrow) and initial shrinkage after 6 months of treatment (B, arrow). Tumour tissue had hypointense signal after gadolinium enhancement whereas the normal hypophysis showed homogeneous enhancement on the left side.

Figure 2

Evolution of GH and IGF1 levels before and on pasireotide-LAR. GH and IGF1 levels are observable for the first 4 years of treatment but remained unchanged until the last visit (July 2023). C, cabergoline; GH, growth hormone; IGF1, insulin-like growth factor 1; LAN, lanreotide (120 mg/28 days); TS, transsphenoidal surgery.