Six-month preoperative octreotide treatment in unselected, de novo patients with acromegaly: effect on biochemistry, tumour volume, and postoperative cure.

Author(s): Carlsen SM, Svartberg J, Schreiner T, Aanderud S, Johannesen O, Skeie S, Lund-Johansen M, Fougner SL, Bollerslev J

Affiliation(s): Unit of Applied Clinical Research, Department of Cancer Research and Molecular Medicine, Norwegian University for Science and Technology, Trondheim, Norway. sven.carlsen@ntnu.no

Publication date & source: 2011-06, Clin Endocrinol (Oxf)., 74(6):736-43.

Publication type: Randomized Controlled Trial

OBJECTIVE: Treatment with somatostatin analogues is the primary medical treatment of acromegaly. Controversies still exist whether acute octreotide effect predicts long-term biochemical effects, tumour regression or surgical cure. This prospective study investigates effect of 6-month treatment with octreotide long-acting repeatable (LAR) on insulin-like growth factor-1 (IGF-1) and growth hormone (GH) levels, pituitary function, tumour regression and postoperative cure in de novo acromegalic patients. DESIGN AND METHODS: After a baseline evaluation including fasting hormone levels, MRI scan and an acute 50 mug octreotide test, 32 patients were treated with octreotide LAR 20 mg every 28th day for 6 months before surgery. Treatment effects on IGF-1 and GH levels, serum hormone levels and tumour volume were monitored. Surgical cure was evaluated 3 months postoperatively. RESULTS: Mean tumour volume reduction was 35%, in one-third of the patients more than 50%, while approximately one-third achieved biochemical remission evaluated by normalized IGF-1 levels. The GH reduction following an acute octreotide test was 81 +/- 19% and associated with long-term GH reduction (r = 0.78, P < 0.0005). However, neither acute (r = 0.29, P = 0.12) nor the long-term octreotide effect (r = 0.11, P = 0.58) on GH levels was associated with tumour volume reduction and did not predict subsequent surgical cure. CONCLUSION: Six months of long-acting octreotide using a fixed dose, 1/3 of the patients came in biochemical remission, while 2/3 had significant tumour reduction. Moreover, an acute effect of octreotide seemed to be a prerequisite for long-term effect. (c) 2011 Blackwell Publishing Ltd.