作者
Marta Araujo‐Castro,Betina Biagetti,Miguel Pocovı́,Iría Novoa-Testa,Fernando Cordido,Eider Pascual‐Corrales,Víctor Rodríguez Berrocal,Fernando Guerrero‐Pérez,Almudena Vicente,Juan Carlos Pércovich Hualpa,Rogelio García-Centeno,Laura González-Fernández,María Dolores Ollero García,Ana Irigaray,María Dolores Moure Rodríguez,Cristina Novo-Rodríguez,María Calatayud,Rocío Villar-Taibo,Ignacio Bernabéu,Cristina Álvarez-Escolá,Pamela Benítez Valderrama,Carmen Tenorio Jiménez,Pablo Abellán Galiana,Eva Venegas,Inmaculada González-Molero,Pedro Iglesias,Concepción Blanco-Carrera,Fernando Vidal-Ostos De Lara,Paz de Miguel Novoa,Elena López Mezquita,Felicia A. Hanzu,Ibán Aldecoa,Silvia Aznar,Cristina Lamas,Anna Aulinas,Queralt Asla,Paola Gracia Gimeno,José María Recio Córdova,María Dolores Avilés-Pérez,Diego Asensio-Wandosel,Miguel Sampedro‐Núñez,Rosa Cámara,Miguel Paja,Ignacio Ruz‐Caracuel,Carmen Fajardo,Mónica Marazuela,Manel Puig‐Domingo
摘要
The objective of the study was to evaluate the efficacy of second-line therapies in patients with acromegaly caused by a growth hormone (GH) and prolactin (PRL) co-secreting pituitary neuroendocrine tumor (GH&PRL-Pit-NET) compared to their efficacy in patients with acromegaly caused by a GH-secreting pituitary neuroendocrine tumor (GH-Pit-NET). This is a multicenter retrospective study of patients with acromegaly on treatment with pasireotide and/or pegvisomant. Patients were classified in two groups: GH&PRL-Pit-NETs when evidence of hyperprolactinemia and immunohistochemistry (IHC) for GH and PRL was positive or if PRL were >200 ng/dL regardless of the PRL-IHC and GH-Pit-NETs when the previously mentioned criteria were not met. A total of 28 cases with GH&PRL-Pit-NETs and 122 with GH-Pit-NETs met the inclusion criteria. GH&PRL-Pit-NETs presented at a younger age, caused hypopituitarism, and were invasive more frequently than GH-Pit-NETs. There were 124 patients treated with pegvisomant and 49 with pasireotide at any time. The efficacy of pegvisomant for IGF-1 normalization was of 81.5% and of pasireotide of 71.4%. No differences in IGF-1 control with pasireotide and with pegvisomant were observed between GH&PRL-Pit-NETs and GH-Pit-NETs. All GH&PRL-Pit-NET cases treated with pasireotide (n = 6) and 82.6% (n = 19/23) of the cases treated with pegvisomant normalized PRL levels. No differences in the rate of IGF-1 control between pegvisomant and pasireotide were detected in patients with GH&PRL-Pit-NETs (84.9% vs 66.7%, P = 0.178). We conclude that despite the more aggressive behavior of GH&PRL-Pit-NETs than GH-Pit-NETs, no differences in the rate of IGF-1 control with pegvisomant and pasireotide were observed between both groups, and both drugs have shown to be effective treatments to control IGF-1 and PRL hypersecretion in these tumors.