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Marques-Pamies M, Gil J, Sampedro-Nuñez M, Valassi E, Biagetti B, Giménez-Palop O, Hernández M, Martínez S, Carrato C, Villar-Taibo R, Araujo-Castro M, Blanco C, Simón-Muela I, Simó-Servat A, Xifra G, Vázquez F, Pavón I, Rosado JA, García-Centeno R, Zavala R, Hanzu FA, Mora M, Aulinas A, Vilarrasa N, Librizzi S, Calatayud M, de Miguel P, Alvarez-Escola C, Picó A, Salinas I, Fajardo-Montañana C, Cámara R, Bernabéu I, Jordà M, Webb SM, Marazuela M, Puig-Domingo M. Personalized Medicine in Acromegaly: The ACROFAST Study. J Clin Endocrinol Metab 2024; 110:30-40. [PMID: 38943661 PMCID: PMC11651705 DOI: 10.1210/clinem/dgae444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 03/25/2024] [Accepted: 06/26/2024] [Indexed: 07/01/2024]
Abstract
CONTEXT Medical treatment of acromegaly is currently performed through a trial-and-error approach using first-generation somatostatin receptor ligands (fgSRLs) as first-line drugs, with an effectiveness of about 50%, and subsequent drugs are indicated through clinical judgment. Some biomarkers can predict fgSRLs response. OBJECTIVE Here we report the results of the ACROFAST study, a clinical trial in which a protocol based on predictive biomarkers of fgSRLs was evaluated. METHODS This was a prospective trial (21 university hospitals) comparing the effectiveness and time-to-control of 2 treatment protocols during 12 months: (A) a personalized protocol in which the first options were fgSRLs as monotherapy or in combination with pegvisomant, or pegvisomant as monotherapy depending on the short acute octreotide test (sAOT) results, tumor T2 magnetic resonance (MRI) signal or immunostaining for E-cadherin; and (B) a control group with treatment always started by fgSRLs and the other drugs included after demonstrating inadequate control. RESULTS Eighty-five patients participated; 45 in the personalized and 40 in the control group. More patients in the personalized protocol achieved hormonal control compared to those in the control group (78% vs 53%, P < .05). Survival analysis revealed a hazard ratio for achieving hormonal control adjusted by age and sex of 2.53 (CI, 1.30-4.80). Patients from the personalized arm were controlled in a shorter period of time (P = .01). CONCLUSION Personalized medicine is feasible using a relatively simple protocol, and it allows a higher number of patients to achieve control in a shorter period of time.
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Affiliation(s)
| | - Joan Gil
- Endocrine Research Unit, Germans Trias i Pujol Research Institute
(IGTP), Badalona 08916, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER,
Unidad 747), Instituto de Salud Carlos III (ISCIII),
Barcelona 28029, Spain
| | - Miguel Sampedro-Nuñez
- Department of Endocrinology and Nutrition, La Princesa University
Hospital, Madrid 28006, Spain
| | - Elena Valassi
- Endocrine Research Unit, Germans Trias i Pujol Research Institute
(IGTP), Badalona 08916, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER,
Unidad 747), Instituto de Salud Carlos III (ISCIII),
Barcelona 28029, Spain
- Department of Endocrinology and Nutrition, Germans Trias i Pujol University
Hospital, Badalona 08916, Spain
| | - Betina Biagetti
- Department of Endocrinology and Nutrition, Vall Hebron University
Hospital, Barcelona 08035, Spain
| | - Olga Giménez-Palop
- Department of Endocrinology and Nutrition, Parc Taulí University
Hospital, Sabadell 08208, Spain
| | - Marta Hernández
- Department of Endocrinology and Nutrition, Arnau de Vilanova University
Hospital, Lleida 25198, Spain
- Endocrine Research Unit, Lleida Institute for Biomedical Research Dr.
Pifarré Foundation (IRBLleida), Lleida 25198,
Spain
| | - Silvia Martínez
- Department Hormonal Laboratory, Germans Trias i Pujol University
Hospital, Badalona 08916, Spain
| | - Cristina Carrato
- Department of Pathology, Germans Trias i Pujol University
Hospital, Badalona 08916, Spain
| | - Rocío Villar-Taibo
- Department of Endocrinology and Nutrition, Clínico de Santiago University
Hospital, Santiago de Compostela 15706, Spain
| | - Marta Araujo-Castro
- Department of Endocrinology and Nutrition, Ramón y Cajal University
Hospital, Madrid 28034, Spain
- Instituto de Investigación Ramón y Cajal (IRYCIS),
Madrid 28034, Spain
| | - Concepción Blanco
- Department of Endocrinology and Nutrition, Príncipe de Asturias University
Hospital, Madrid 28805, Spain
| | - Inmaculada Simón-Muela
- Department of Endocrinology and Nutrition, Joan XXIII University
Hospital, Tarragona 43005, Spain
- Endocrine Research Unit, Institut d´Investigació Sanitària Pere Virgili
(IISPV), Tarragona 43005, Spain
- Rovira i Virgili University (URV), Tarragona
43003, Spain
- Endocrine Research Unit, Institut d'Investigació Biomèdica de Bellvitge
(IDIBELL), Hospitalet de LLobregat 08907,
Spain
| | - Andreu Simó-Servat
- Department of Endocrinology and Nutrition, Mutua de Terrassa University
Hospital, Terrassa 08221, Spain
| | - Gemma Xifra
- Department of Endocrinology and Nutrition, Josep Trueta University
Hospital, Girona 17007, Spain
| | - Federico Vázquez
- Department of Endocrinology and Nutrition, Germans Trias i Pujol University
Hospital, Badalona 08916, Spain
| | - Isabel Pavón
- Department of Endocrinology and Nutrition, Getafe University
Hospital, Madrid 28905, Spain
| | - José Antonio Rosado
- Department of Endocrinology and Nutrition, Getafe University
Hospital, Madrid 28905, Spain
| | - Rogelio García-Centeno
- Department of Endocrinology and Nutrition, Gregorio Marañón University
Hospital, Madrid 28007, Spain
| | - Roxana Zavala
- Department of Endocrinology and Nutrition, Joan XXIII University
Hospital, Tarragona 43005, Spain
| | - Felicia Alexandra Hanzu
- Department of Endocrinology and Nutrition, Hospital Clinic University
Hospital, Barcelona 08036, Spain
- Endocrine Research Unit, Institut d’Investigacions Biomèdiques August Pi I
Sunyer (IDIBAPS), Barcelona 08036, Spain
| | - Mireia Mora
- Department of Endocrinology and Nutrition, Hospital Clinic University
Hospital, Barcelona 08036, Spain
- Endocrine Research Unit, Institut d’Investigacions Biomèdiques August Pi I
Sunyer (IDIBAPS), Barcelona 08036, Spain
| | - Anna Aulinas
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER,
Unidad 747), Instituto de Salud Carlos III (ISCIII),
Barcelona 28029, Spain
- Department of Endocrinology and Nutrition, Research Center for Pituitary
Diseases, Institut de Recerca Sant Pau (IIB-Sant Pau), Hospital Sant
Pau, Barcelona 08041, Spain
| | - Nuria Vilarrasa
- Endocrine Research Unit, Institut d'Investigació Biomèdica de Bellvitge
(IDIBELL), Hospitalet de LLobregat 08907,
Spain
- Department of Endocrinology and Nutrition, Bellvitge University
Hospital, Hospitalet de Llobregat 08907, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades
Metabólicas (CIBERDEM), Instituto de Salud Carlos III (ISCIII),
Madrid 28029, Spain
| | - Soledad Librizzi
- Department of Endocrinology and Nutrition, 12 de Octubre University
Hospital, Madrid 28041, Spain
| | - María Calatayud
- Department of Endocrinology and Nutrition, 12 de Octubre University
Hospital, Madrid 28041, Spain
| | - Paz de Miguel
- Department of Endocrinology and Nutrition, Clínico San Carlos University
Hospital, Madrid 2546, Spain
| | | | - Antonio Picó
- Department of Endocrinology and Nutrition, General University Hospital Dr
Balmis, Miguel Hernández University, Alicante
03010, Spain
- Endocrine Research Unit, Instituto de Investigación Sanitaria y Biomédica
de Alicante (ISABIAL), Alicante 03010, Spain
| | - Isabel Salinas
- Department of Endocrinology and Nutrition, Germans Trias i Pujol University
Hospital, Badalona 08916, Spain
| | | | - Rosa Cámara
- Department of Endocrinology and Nutrition, La Fe University
Hospital, Valencia 46026, Spain
| | - Ignacio Bernabéu
- Department of Endocrinology and Nutrition, Clínico de Santiago University
Hospital, Santiago de Compostela 15706, Spain
| | - Mireia Jordà
- Endocrine Research Unit, Germans Trias i Pujol Research Institute
(IGTP), Badalona 08916, Spain
| | - Susan M Webb
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER,
Unidad 747), Instituto de Salud Carlos III (ISCIII),
Barcelona 28029, Spain
- Department of Endocrinology and Nutrition, Research Center for Pituitary
Diseases, Institut de Recerca Sant Pau (IIB-Sant Pau), Hospital Sant
Pau, Barcelona 08041, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona
(UAB), Bellaterra 08193, Spain
| | - Mónica Marazuela
- Department of Endocrinology and Nutrition, La Princesa University
Hospital, Madrid 28006, Spain
| | - Manel Puig-Domingo
- Endocrine Research Unit, Germans Trias i Pujol Research Institute
(IGTP), Badalona 08916, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER,
Unidad 747), Instituto de Salud Carlos III (ISCIII),
Barcelona 28029, Spain
- Department of Endocrinology and Nutrition, Germans Trias i Pujol University
Hospital, Badalona 08916, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona
(UAB), Bellaterra 08193, Spain
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Marques-Pamies M, Gil J, Valassi E, Pons L, Carrato C, Jordà M, Puig-Domingo M. New molecular tools for precision medicine in pituitary neuroendocrine tumors. Minerva Endocrinol (Torino) 2024; 49:300-320. [PMID: 38261299 DOI: 10.23736/s2724-6507.23.04063-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Precision, personalized, or individualized medicine in pituitary neuroendocrine tumors (PitNETs) has become a major topic in the last few years. It is based on the use of biomarkers that predictively segregate patients and give answers to clinically relevant questions that help us in the individualization of their management. It allows us to make early diagnosis, predict response to medical treatments, predict surgical outcomes and investigate new targets for therapeutic molecules. So far, substantial progress has been made in this field, although there are still not enough precise tools that can be implemented in clinical practice. One of the main reasons is the excess overlap among clustered patients, with an error probability that is not currently acceptable for clinical practice. This overlap is due to the high heterogeneity of PitNETs, which is too complex to be overcome by the classical biomarker investigation approach. A systems biology approach based on artificial intelligence techniques seems to be able to give answers to each patient individually by building mathematical models through the interaction of multiple factors, including those of omics sciences. Integrated studies of different molecular omics techniques, as well as radiomics and clinical data are necessary to understand the whole system and to finally achieve the key to obtain precise biomarkers and implement personalized medicine. In this review we have focused on describing the current advances in the area of PitNETs based on the omics sciences, that are clearly going to be the new tool for precision medicine.
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Affiliation(s)
| | - Joan Gil
- Endocrine Research Unit, Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
- Centro de Investigación en Red de Enfermedades Raras (CIBERER), Health Institute of Carlos III, Madrid, Spain
- Department of Endocrinology, Research Center for Pituitary Diseases, Sant Pau Hospital, Barcelona, Spain
| | - Elena Valassi
- Centro de Investigación en Red de Enfermedades Raras (CIBERER), Health Institute of Carlos III, Madrid, Spain
- Department of Endocrinology and Nutrition, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Laura Pons
- Department of Pathology, Germans Trias i Pujol Hospital, Badalona, Spain
| | - Cristina Carrato
- Department of Pathology, Germans Trias i Pujol Hospital, Badalona, Spain
| | - Mireia Jordà
- Endocrine Research Unit, Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
| | - Manel Puig-Domingo
- Endocrine Research Unit, Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain -
- Centro de Investigación en Red de Enfermedades Raras (CIBERER), Health Institute of Carlos III, Madrid, Spain
- Department of Endocrinology and Nutrition, Germans Trias i Pujol University Hospital, Badalona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
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Veleno M, Giampietro A, Raia S, Menotti S, Tartaglione T, Gaudino S, Doglietto F, DE Marinis L, Pontecorvi A, Chiloiro S, Bianchi A. Clinical implications of the 2022 WHO classification on the multidisciplinary management of PitNETS patients. Minerva Endocrinol (Torino) 2024; 49:269-282. [PMID: 38963295 DOI: 10.23736/s2724-6507.24.04126-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
The review explores the 2022 update to the World Health Organization (WHO) classification of pituitary adenomas, now referred to as pituitary neuroendocrine tumors (PitNETs), and his possible impact on the clinical management of PitNET patients. The review highlights the differences and the evolution from the 2017 to 2022 version, with the current classification considering the lineage of the tumor cells, cell type, hormones produced, and other auxiliary characteristics for a comprehensive histological classification. The revision in terminology reflects a broader perspective on neuroendocrine neoplasia. The new approach based on transcription factors, hormone expression and other biomarkers has allowed a major revision of the nomenclature and a more accurate classification of pituitary adenomas. Furthermore, in some cases this approach is also assuming a prognostic value, useful in clinical practice. However, despite this elaborate classification and stratification, the review points out the lack of a robust grading or staging system and suggests the need for further research and validation of diagnostic methods. Despite these limitations, the revised classification presents a significant step towards understanding and managing PitNETs patients.
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Affiliation(s)
- Miriam Veleno
- Pituitary Unit, Department of Internal Medicine, Endocrinology and Diabetes, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Department of Translational Medicine and Surgery, Sacred Heart Catholic University, Rome, Italy
| | - Antonella Giampietro
- Pituitary Unit, Department of Internal Medicine, Endocrinology and Diabetes, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Department of Translational Medicine and Surgery, Sacred Heart Catholic University, Rome, Italy
| | - Salvatore Raia
- Pituitary Unit, Department of Internal Medicine, Endocrinology and Diabetes, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Department of Translational Medicine and Surgery, Sacred Heart Catholic University, Rome, Italy
| | - Sara Menotti
- Pituitary Unit, Department of Internal Medicine, Endocrinology and Diabetes, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Department of Translational Medicine and Surgery, Sacred Heart Catholic University, Rome, Italy
| | - Tommaso Tartaglione
- Department of Translational Medicine and Surgery, Sacred Heart Catholic University, Rome, Italy
- Department of Radiodiagnostic, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Simona Gaudino
- Department of Translational Medicine and Surgery, Sacred Heart Catholic University, Rome, Italy
- Department of Radiodiagnostic, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Francesco Doglietto
- Department of Translational Medicine and Surgery, Sacred Heart Catholic University, Rome, Italy
- Department of Neurosurgery, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Laura DE Marinis
- Pituitary Unit, Department of Internal Medicine, Endocrinology and Diabetes, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Department of Translational Medicine and Surgery, Sacred Heart Catholic University, Rome, Italy
| | - Alfredo Pontecorvi
- Pituitary Unit, Department of Internal Medicine, Endocrinology and Diabetes, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Department of Translational Medicine and Surgery, Sacred Heart Catholic University, Rome, Italy
| | - Sabrina Chiloiro
- Pituitary Unit, Department of Internal Medicine, Endocrinology and Diabetes, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy -
- Department of Translational Medicine and Surgery, Sacred Heart Catholic University, Rome, Italy
| | - Antonio Bianchi
- Pituitary Unit, Department of Internal Medicine, Endocrinology and Diabetes, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Department of Translational Medicine and Surgery, Sacred Heart Catholic University, Rome, Italy
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Luo M, Yu J, Tang R. Immunological signatures and predictive biomarkers for first-generation somatostatin receptor ligand resistance in Acromegaly. J Neurooncol 2024; 167:415-425. [PMID: 38441839 DOI: 10.1007/s11060-024-04620-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/23/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE Predicting resistance to first-generation Somatostatin Receptor Ligands (fg-SRL) in Acromegaly patients remains an ongong challenge. Tumor-associated immune components participate in various pathological processes, including drug-resistance. We aimed to identify the immune components involved in resistance of fg-SRL, and to investigate biomarkers that can be targeted to treat those drug-resistant Acromegaly. METHODS We conducted a retrospective study involving 35 Acromegaly patients with somatotropinomas treated postoperatively with fg-SRL. Gathering clinicopathological data, SSTR2 expression, and immunological profiles, we utilized univariate, binary logistic regression, and ROC analyses to assess their predictive roles in fg-SRL resistance. Spearman correlation analysis further examined interactions among interested characteristics. RESULTS 19 patients (54.29%) exhibited resistance to postoperative fg-SRL. GH level at diagnosis, preoperative tumor volume, T2WI-MRI intensity, granularity, PD-L1, SSTR2, and CD8 + T cell infiltration showed association with clinical outcomes of fg-SRL. Notably, T2WI-MRI hyperintensity, PD-L1-IRS > 7, CD8 + T cell infiltration < 14.8/HPF, and SSTR2-IRS < 5.4 emerged as reliable predictors for fg-SRL resistance. Correlation analysis highlighted a negative relationship between PD-L1 expression and CD8 + T cell infiltration, while showcasing a positive correlation with preoperative tumor volume of somatotropinomas. Additionally, 5 patients with fg-SRL resistance underwent re-operation were involved. Following fg-SRL treatment, significant increases in PD-L1 and SSTR5 expression were observed, while SSTR2 expression decreased in somatotropinoma. CONCLUSION PD-L1 expression and CD8 + T cell infiltration, either independently or combined with SSTR2 expression and T2WI-MRI intensity, could form a predictive model guiding clinical decisions on fg-SRL employment. Furthermore, targeting PD-L1 through immunotherapy and embracing second-generations of SRL with higher affinity to SSTR5 represent promising strategies to tackle fg-SRL resistance in somatotropinomas.
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Affiliation(s)
- Mei Luo
- Department of Neurosurgery, The Second Xiangya Hospital of Central South University, 410011, Changsha, Hunan, China
- Department of Neurosurgery and Pituitary Tumor Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jiangfan Yu
- Department of Pediatric Dermatology, Dermatology Hospital of Southern Medical University, 510091, Guangzhou, China
| | - Rui Tang
- Department of Rheumatology and Immunology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
- Clinical Medical Research Center for Systemic Autoimmune Diseases, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Kasuki L, Lamback E, Antunes X, Gadelha MR. Biomarkers of response to treatment in acromegaly. Expert Rev Endocrinol Metab 2024; 19:71-80. [PMID: 38078447 DOI: 10.1080/17446651.2023.2293107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/06/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Medical treatment of acromegaly is based in a `trial and error` approach. First-generation somatostatin receptor ligands (fg-SRL) are prescribed as first-line medical therapy to the vast majority of patients, despite lack of disease control in approximately 60% of patients. However, other drugs used in acromegaly treatment are available (cabergoline, pasireotide and pegvisomant). AREAS COVERED In this article, we review and discuss the biomarkers of response to medical treatment in acromegaly. EXPERT OPINION Biomarkers for fg-SRL that can already be applied in clinical practice are: gender, age, pretreatment GH and IGF-I levels, cytokeratin granulation pattern, and the expression of somatostatin receptor type 2. Using biomarkers of response could guide treatment towards precision medicine with greater efficacy and lower costs.
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Affiliation(s)
- Leandro Kasuki
- Neuroendocrinology Research Center/Endocrinology Division, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Neuroendocrinology Division, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
- Endocrinology Division, Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil
| | - Elisa Lamback
- Neuroendocrinology Research Center/Endocrinology Division, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Neuroendocrinology Division, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
- Neuropathology and Molecular Genetics Laboratory, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
| | - Ximene Antunes
- Neuroendocrinology Research Center/Endocrinology Division, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mônica R Gadelha
- Neuroendocrinology Research Center/Endocrinology Division, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Neuroendocrinology Division, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
- Neuropathology and Molecular Genetics Laboratory, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
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Vuong HG, Dunn IF. Clinical and prognostic significance of granulation patterns in somatotroph adenomas/tumors of the pituitary: a meta-analysis. Pituitary 2023; 26:653-659. [PMID: 37735314 DOI: 10.1007/s11102-023-01353-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION Sparsely granulated somatotroph adenoma/tumor (SGST) is thought to be more clinically aggressive than densely granulated somatotroph adenoma/tumor (DGST). However, the literature is not entirely consistent as to the disparate demographic and behavioral features of these subtypes. In this study, we conducted a meta-analysis to further clarify the demographic, clinicopathological, prognostic, and molecular characteristics of SGST versus DGST. METHODS We accessed two electronic databases to search for potential data. Pooled estimates of odds ratio (OR), mean difference (MD), and corresponding 95% confidence interval (CI) were calculated using the random-effect model. RESULTS SGST was associated with younger patient age and lower male-to-female ratio (p < 0.001) compared to DGST. Clinically, SGST had larger tumor size and high rate of cavernous sinus and suprasellar extension (p < 0.001) than DGST. During postoperative follow-up, SGST was associated with a lower endocrinological remission rate (OR 0.60; 95% CI 0.40 to 0.90; p = 0.01) and a poorer response rate to SRL (OR 0.16; 95% CI 0.08-0.35; p < 0.001) in comparison to DGST. The prevalence of GSP mutations was significantly lower in SGST (OR 0.36; 95% CI 0.17 to 0.79; p = 0.01). CONCLUSION SGST and DGST were demographically, clinicopathologically, and molecularly different from each other with the former associated with adverse treatment outcomes and poor response to medical therapy. There are still gaps in translational studies that could help us better understand the behavior of these tumors and identify potential targets in the treatment of sparsely granulated tumors.
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Affiliation(s)
- Huy Gia Vuong
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52241, USA
| | - Ian F Dunn
- Department of Neurosurgery, Oklahoma University Health Sciences Center, Oklahoma City, OK, 73104, USA.
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Marques-Pamies M, Gil J, Jordà M, Puig-Domingo M. Predictors of Response to Treatment with First-Generation Somatostatin Receptor Ligands in Patients with Acromegaly. Arch Med Res 2023; 54:102924. [PMID: 38042683 DOI: 10.1016/j.arcmed.2023.102924] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/27/2023] [Accepted: 11/17/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND AND AIMS Predictors of first-generation somatostatin receptor ligands (fgSRLs) response in acromegaly have been studied for over 30 years, but they are still not recommended in clinical guidelines. Is there not enough evidence to support their use? This systematic review aims to describe the current knowledge of the main predictors of fgSRLs response and discuss their current usefulness, as well as future research directions. METHODS A systematic search was performed in the Scopus and PubMed databases for functional, imaging, and molecular predictive factors. RESULTS A total of 282 articles were detected, of which 64 were included. Most of them are retrospective studies performed between 1990 and 2023 focused on the predictive response to fgSRLs in acromegaly. The usefulness of the predictive factors is confirmed, with good response identified by the most replicated factors, specifically low GH nadir in the acute octreotide test, T2 MRI hypointensity, high Somatostatin receptor 2 (SSTR2) and E-cadherin expression, and a densely granulated pattern. Even if these biomarkers are interrelated, the association is quite heterogeneous. With classical statistical methods, it is complex to define reliable and generalizable cut-off values worth recommending in clinical guidelines. Machine-learning models involving omics are a promising approach to achieve the highest accuracy values to date. CONCLUSIONS This survey confirms a sufficiently robust level of evidence to apply knowledge of predictive factors for greater efficiency in the treatment decision process. The irruption of artificial intelligence in this field is providing definitive answers to such long-standing questions that may change clinical guidelines and make personalized medicine a reality.
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Affiliation(s)
| | - Joan Gil
- Endocrine Research Unit, Germans Trias i Pujol Research Institute, Badalona, Spain; Network Research Center for Rare Diseases, CIBERER, Unit 747, Instituto de Salud Carlos III, Madrid, Spain; Department of Endocrinology, Research Center for Pituitary Diseases, Hospital Sant Pau, IIB-SPau, Barcelona, Spain
| | - Mireia Jordà
- Endocrine Research Unit, Germans Trias i Pujol Research Institute, Badalona, Spain
| | - Manel Puig-Domingo
- Endocrine Research Unit, Germans Trias i Pujol Research Institute, Badalona, Spain; Network Research Center for Rare Diseases, CIBERER, Unit 747, Instituto de Salud Carlos III, Madrid, Spain; Department of Endocrinology and Nutrition, Germans Trias i Pujol University Hospital, Badalona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Marques-Pamies M, Gil J, Valassi E, Hernández M, Biagetti B, Giménez-Palop O, Martínez S, Carrato C, Pons L, Villar-Taibo R, Araujo-Castro M, Blanco C, Simón I, Simó-Servat A, Xifra G, Vázquez F, Pavón I, García-Centeno R, Zavala R, Hanzu FA, Mora M, Aulinas A, Vilarrasa N, Librizzi S, Calatayud M, de Miguel P, Alvarez-Escola C, Picó A, Sampedro M, Salinas I, Fajardo-Montañana C, Cámara R, Bernabéu I, Jordà M, Webb SM, Marazuela M, Puig-Domingo M. Revisiting the usefulness of the short acute octreotide test to predict treatment outcomes in acromegaly. Front Endocrinol (Lausanne) 2023; 14:1269787. [PMID: 38027102 PMCID: PMC10654626 DOI: 10.3389/fendo.2023.1269787] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction We previously described that a short version of the acute octreotide test (sAOT) can predict the response to first-generation somatostatin receptor ligands (SRLs) in patients with acromegaly. We have prospectively reassessed the sAOT in patients from the ACROFAST study using current ultra-sensitive GH assays. We also studied the correlation of sAOT with tumor expression of E-cadherin and somatostatin receptor 2 (SSTR2) . Methods A total of 47 patients treated with SRLs for 6 months were evaluated with the sAOT at diagnosis and correlated with SRLs' response. Those patients whose IGF1 decreased to <3SDS from normal value were considered responders and those whose IGF1 was ≥3SDS, were considered non-responders. The 2 hours GH value (GH2h) after s.c. administration of 100 mcg of octreotide was used to define predictive cutoffs. E-cadherin and SSTR2 immunostaining in somatotropinoma tissue were investigated in 24/47 and 18/47 patients, respectively. Results In all, 30 patients were responders and 17 were non-responders. GH2h was 0.68 (0.25-1.98) ng/mL in responders vs 2.35 (1.59-9.37) ng/mL in non-responders (p<0.001). GH2h = 1.4ng/mL showed the highest ability to identify responders (accuracy of 81%, sensitivity of 73.3%, and specificity of 94.1%). GH2h = 4.3ng/mL was the best cutoff for non-response prediction (accuracy of 74%, sensitivity of 35.3%, and specificity of 96.7%). Patients with E-cadherin-positive tumors showed a lower GH2h than those with E-cadherin-negative tumors [0.9 (0.3-2.1) vs 3.3 (1.5-12.1) ng/mL; p<0.01], and patients with positive E-cadherin presented a higher score of SSTR2 (7.5 ± 4.2 vs 3.3 ± 2.1; p=0.01). Conclusion The sAOT is a good predictor tool for assessing response to SRLs and correlates with tumor E-cadherin and SSTR2 expression. Thus, it can be useful in clinical practice for therapeutic decision-making in patients with acromegaly.
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Affiliation(s)
| | - Joan Gil
- Endocrine Research Unit, Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Elena Valassi
- Endocrine Research Unit, Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Department of Endocrinology and Nutrition, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Marta Hernández
- Department of Endocrinology and Nutrition, Arnau de Vilanova University Hospital, Lleida, Spain
- Endocrine Research Unit, Lleida Institute for Biomedical Research Dr. Pifarré Foundation (IRBLleida), Lleida, Spain
| | - Betina Biagetti
- Department of Endocrinology and Nutrition, Vall Hebron University Hospital, Barcelona, Spain
| | - Olga Giménez-Palop
- Department of Endocrinology and Nutrition, Parc Taulí University Hospital, Sabadell, Spain
| | - Silvia Martínez
- Department Hormonal Laboratory, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Cristina Carrato
- Department of Pathology, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Laura Pons
- Department of Pathology, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Rocío Villar-Taibo
- Department of Endocrinology and Nutrition, Clínico de Santiago University Hospital, Santiago de Compostela, Spain
| | - Marta Araujo-Castro
- Department of Endocrinology and Nutrition, Ramón y Cajal University Hospital, Madrid, Spain
| | - Concepción Blanco
- Department of Endocrinology and Nutrition, Príncipe de Asturias University Hospital, Madrid, Spain
| | - Inmaculada Simón
- Department of Endocrinology and Nutrition, Joan XXIII University Hospital, Tarragona, Spain
| | - Andreu Simó-Servat
- Department of Endocrinology and Nutrition, Mutua de Terrassa University Hospital, Terrassa, Spain
| | - Gemma Xifra
- Department of Endocrinology and Nutrition, Josep Trueta University Hospital, Girona, Spain
| | - Federico Vázquez
- Department of Endocrinology and Nutrition, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Isabel Pavón
- Department of Endocrinology and Nutrition, Getafe University Hospital, Madrid, Spain
| | - Rogelio García-Centeno
- Department of Endocrinology and Nutrition, Gregorio Marañón University Hospital, Madrid, Spain
| | - Roxana Zavala
- Department of Endocrinology and Nutrition, Joan XXIII University Hospital, Tarragona, Spain
| | - Felicia Alexandra Hanzu
- Department of Endocrinology and Nutrition, Hospital Clinic University Hospital, Barcelona, Spain
- Endocrine Research Unit, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Mireia Mora
- Department of Endocrinology and Nutrition, Hospital Clinic University Hospital, Barcelona, Spain
- Endocrine Research Unit, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Anna Aulinas
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Department of Endocrinology and Nutrition, Hospital Sant Pau, Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Departament de Medicina, Barcelona, Spain
| | - Nuria Vilarrasa
- Department of Endocrinology and Nutrition, Bellvitge University Hospital, Bellvitge, Spain
- Endocrine Research Unit, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Bellvitge, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Soledad Librizzi
- Department of Endocrinology and Nutrition, 12 de Octubre University Hospital, Madrid, Spain
| | - María Calatayud
- Department of Endocrinology and Nutrition, 12 de Octubre University Hospital, Madrid, Spain
| | - Paz de Miguel
- Department of Endocrinology and Nutrition, Clínico San Carlos University Hospital, Madrid, Spain
| | | | - Antonio Picó
- Department of Endocrinology and Nutrition, General University Hospital Dr Balmis, Miguel Hernández University, Alicante, Spain
- Endocrine Research Unit, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Miguel Sampedro
- Department of Endocrinology and Nutrition, La Princesa University Hospital, Madrid, Spain
| | - Isabel Salinas
- Department of Endocrinology and Nutrition, Germans Trias i Pujol University Hospital, Badalona, Spain
| | | | - Rosa Cámara
- Department of Endocrinology and Nutrition, La Fe University Hospital, Valencia, Spain
| | - Ignacio Bernabéu
- Department of Endocrinology and Nutrition, Clínico de Santiago University Hospital, Santiago de Compostela, Spain
| | - Mireia Jordà
- Endocrine Research Unit, Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
| | - Susan M. Webb
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Department of Endocrinology and Nutrition, Hospital Sant Pau, Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Departament de Medicina, Barcelona, Spain
| | - Mónica Marazuela
- Department of Endocrinology and Nutrition, La Princesa University Hospital, Madrid, Spain
| | - Manel Puig-Domingo
- Endocrine Research Unit, Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Department of Endocrinology and Nutrition, Germans Trias i Pujol University Hospital, Badalona, Spain
- Universitat Autònoma de Barcelona (UAB), Departament de Medicina, Barcelona, Spain
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