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Chen JS, Bai LY, Cheng HH, Chan SL, Zou JY, Shi X, Houchard A, Truong-Thanh XM, Chen MH. Real-World Study of Lanreotide Autogel in Routine Practice in Patients with Gastroenteropancreatic Neuroendocrine Tumors (GEP-NETs) in Hong Kong and Taiwan. Oncol Ther 2024:10.1007/s40487-024-00302-6. [PMID: 39215958 DOI: 10.1007/s40487-024-00302-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 08/15/2024] [Indexed: 09/04/2024] Open
Abstract
INTRODUCTION There is a lack of data on the efficacy, effectiveness, and safety of lanreotide autogel in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs) of Chinese ethnicity. This non-interventional, retrospective study evaluated the effectiveness and safety of lanreotide autogel in patients of Chinese ethnicity with GEP-NETs in clinical practice. METHODS Patient charts were abstracted from five hospitals in Hong Kong and Taiwan (July-September 2021), where lanreotide autogel is approved for treating GEP-NETs. Included patients were adults with unresectable, metastatic, or locally advanced GEP-NETs who received a first injection (index) of lanreotide autogel 120 mg between 01 January 2017 and 30 June 2020 (planned sample size: N = 30). Follow-up ran from index to a maximum of 48 (± 4) weeks or until disease progression, start of new antitumor treatment, or death. The primary endpoint was progression-free survival (PFS) rate at week 48 (±4), and secondary endpoints included PFS rate at week 24 (±4), estimated using Kaplan-Meier analyses. All analyses were descriptive. RESULTS Of 27 patients enrolled, 22 (81.5%) had 48 weeks of follow-up. Tumors of pancreatic origin were the most common (73.9%). PFS rate was 0.96 (95% confidence interval: 0.72 - 0.99) at 24 weeks and 0.82 (0.53-0.94) at 48 weeks. Overall, 74.1% patients experienced ≥ 1 treatment-emergent adverse event; none were serious. No deaths were reported. CONCLUSIONS Lanreotide autogel was well tolerated and showed good tumor control rate in a real-world setting. These findings align with results from previous studies in Caucasian, Japanese, and Korean patients, thus supporting lanreotide autogel for treating patients with GEP-NETs of Chinese ethnicity.
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Affiliation(s)
- Jen-Shi Chen
- Department of Hematology-Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Li-Yuan Bai
- Division of Hematology and Oncology, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | | | - Stephen Lam Chan
- State Key Laboratory of Translational Oncology, Department of Clinical Oncology, Sir YK Pao Centre for Cancer, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | | | | | | | | | - Ming-Huang Chen
- Department of Oncology, Taipei Veterans General Hospital, Taipei City, 11217, Taiwan.
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Omidian H, Wilson RL. Long-Acting Gel Formulations: Advancing Drug Delivery across Diverse Therapeutic Areas. Pharmaceuticals (Basel) 2024; 17:493. [PMID: 38675454 PMCID: PMC11053897 DOI: 10.3390/ph17040493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/04/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
This multifaceted landscape of long-acting gels in diverse medical fields, aims to enhance therapeutic outcomes through localized treatment and controlled drug release. The objective involves advancements spanning cancer treatment, immunotherapy, diabetes management, neuroendocrine disorders, ophthalmic applications, contraception, HIV/AIDS treatment, chronic diseases, wound care, and antimicrobial treatments. It explores the potential of long-acting gels to offer sustained and extended drug release, targeted therapy, and innovative administration routes while addressing limitations such as scalability challenges and regulatory hurdles. Future directions focus on personalized therapies, biodegradability, combination therapies, interdisciplinary innovation, regulatory considerations, and patient-centric development. This comprehensive review highlights the pivotal role of long-acting gels in transforming therapeutic approaches and improving patient outcomes across various medical conditions.
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Affiliation(s)
- Hossein Omidian
- Barry and Judy Silverman College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL 33328, USA;
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Bolanowski M, Kałużny M, Witek P, Jawiarczyk-Przybyłowska A. Pasireotide-a novel somatostatin receptor ligand after 20 years of use. Rev Endocr Metab Disord 2022; 23:601-620. [PMID: 35067849 PMCID: PMC9156514 DOI: 10.1007/s11154-022-09710-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 11/03/2022]
Abstract
Pasireotide, a novel multireceptor-targeted somatostatin receptor ligand (SRL) is characterized by a higher affinity to somatostatin receptor type 5 than type 2, unlike first-generation SRLs. Because of the broader binding profile, pasireotide has been suggested to have a greater clinical efficacy in acromegaly than first-generation SRLs and to be efficacious in Cushing's disease. The consequence of this binding profile is the increased blood glucose level in some patients. This results from the inhibition of both insulin secretion and the incretin effect and only a modest suppression of glucagon. A monthly intramuscular formulation of long-acting release pasireotide has been approved for both acromegaly and Cushing's disease treatment. This review presents data on the efficacy and safety of pasireotide treatment mostly in patients with acromegaly and Cushing's disease. Moreover, other possible therapeutic applications of pasireotide are mentioned.
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Affiliation(s)
- Marek Bolanowski
- Department of Endocrinology, Diabetes and Isotope Therapy, Wrocław Medical University, Wrocław, Poland.
| | - Marcin Kałużny
- Department of Endocrinology, Diabetes and Isotope Therapy, Wrocław Medical University, Wrocław, Poland
| | - Przemysław Witek
- Department of Internal Medicine, Endocrinology and Diabetes, Mazovian Bródno Hospital, Medical University of Warsaw, Warsaw, Poland
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Gezer E, Demirhan Y, Selek A, Cantürk Z, Çetinarslan B, Sözen M, Köksalan D, Karatoprak AP. Comparison between somatostatin analog injections. REVISTA DA ASSOCIAÇÃO MÉDICA BRASILEIRA 2022; 68:514-518. [DOI: 10.1590/1806-9282.20211224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/22/2022] [Indexed: 11/22/2022]
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Wang J, Li H, Xu B. Biological functions of supramolecular assemblies of small molecules in cellular environment. RSC Chem Biol 2021; 2:289-305. [PMID: 34423303 PMCID: PMC8341129 DOI: 10.1039/d0cb00219d] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 01/05/2021] [Indexed: 12/29/2022] Open
Abstract
Like biomacromolecules, certain small molecules (e.g., aggregators) are able to self-assemble in aqueous phase to form nanoscale aggregates. Though it is well-established that the aggregates may interact with enzymes in vitro, the study of the biological activities of the assemblies of small molecules in cellular environment is only at its beginning. This review summarizes the recent progresses in exploring the biological functions of supramolecular assemblies of small molecules (SASMs). We first discuss the use of SASMs to inhibit pathogenic cells, such as cancer cells and bacteria. The use of SASMs to target different parts of cancer cells, such as pericellular space, cytosol, and subcellular organelles, and to combine with other bioactive entities (e.g., proteins and clinically used drugs), is particularly promising for addressing the challenge of acquired multidrug resistance in cancer therapy. Then, we describe the use of SASMs to sustain physiological functions of normal cells, that is, promoting cells proliferation and differentiation for tissue regeneration. After that, we show the use of SASMs as a basic tool to research cell behaviors, for instance, identifying the specific cells, improving enzyme probes, revealing membrane dynamics, enhancing molecular imaging, and mimicking context-dependent signaling. Finally, we give the outlook of the research of SASMs. We expect that this review, by highlighting the biological functions of SASMs, provides a starting point to explore the chemical biology of SASMs.
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Affiliation(s)
- Jingyu Wang
- School of Biomedical Engineering and Technology, Tianjin Medical UniversityTianjin 300070P. R. China
| | - Hui Li
- School of Biomedical Engineering and Technology, Tianjin Medical UniversityTianjin 300070P. R. China
| | - Bing Xu
- Department of Chemistry, Brandeis UniversityWalthamMassachusetts 02454USA
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Fleseriu M, Molitch M, Dreval A, Biermasz NR, Gordon MB, Crosby RD, Ludlam WH, Haviv A, Gilgun-Sherki Y, Mathias SD. Disease and Treatment-Related Burden in Patients With Acromegaly Who Are Biochemically Controlled on Injectable Somatostatin Receptor Ligands. Front Endocrinol (Lausanne) 2021; 12:627711. [PMID: 33790860 PMCID: PMC8006928 DOI: 10.3389/fendo.2021.627711] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/13/2021] [Indexed: 01/17/2023] Open
Abstract
Medical treatment for acromegaly commonly involves receiving intramuscular or deep subcutaneous injections of somatostatin receptor ligands (SRLs) in most patients. In addition to side effects of treatment, acromegaly patients often still experience disease symptoms even when therapy is successful in controlling GH and IGF-1 levels. Symptoms and side effects can negatively impact patients' health-related quality of life. In this study, we examine the disease- and treatment-related burden associated with SRL injections as reported through the use of the Acromegaly Treatment Satisfaction Questionnaire (Acro-TSQ ©) and clinician-reported symptom severity through the Acromegaly Index of Severity (AIS). Patients included in this analysis were enrolled in a randomized phase 3 study, were biochemically-controlled (an IGF-1 < 1.3 × the upper limit of normal [ULN] and average GH < 2.5 ng/ml) and receiving SRL injections for ≥6 months with a stable dose of either long-acting octreotide or lanreotide monotherapy for ≥4 months. The sample (N = 91) was 65% female, 91% Caucasian, with a mean [standard deviation (SD)] age of 53 (1) years. Two-thirds of patients reported that they still experience acromegaly symptoms; 82% of these said they experience symptoms all of the time. Three-fourths experienced gastrointestinal (GI) side effects after injections, and 77% experienced treatment-related injection site reactions (ISRs). Patients commonly reported that these interfered with their daily life, leisure, and work activities. Those with higher symptom severity, as measured by the AIS, scored significantly worse on several Acro-TSQ domains: Symptom Interference, GI Interference, Treatment Satisfaction, and Emotional Reaction. Despite being biochemically controlled with injectable SRLs, most patients reported experiencing acromegaly symptoms that interfere with daily life, leisure, and work. GI side effects and ISRs were also common. This study highlights the significant disease burden that still persists for patients with acromegaly that have achieved biochemical control with the use of injectable SRLs.
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Affiliation(s)
- Maria Fleseriu
- Pituitary Center, Departments of Medicine and Neurological Surgery, Oregon Health and Science University, Portland, OR, United States
- *Correspondence: Maria Fleseriu,
| | - Mark Molitch
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Alexander Dreval
- Department of Clinical Endocrinology, Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia
| | - Nienke R. Biermasz
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands
| | - Murray B. Gordon
- Allegheny Neuroendocrinology Center, Allegheny General Hospital, Pittsburgh, PA, United States
| | - Ross D. Crosby
- Outcomes Research, Health Outcomes Solutions, Winter Park, FL, United States
- Biomedical Statistics, Sanford Center for Biobehavioral Research, Fargo, ND, United States
| | | | - Asi Haviv
- Clinical Development, Chiasma, Inc., Needham, MA, United States
| | | | - Susan D. Mathias
- Outcomes Research, Health Outcomes Solutions, Winter Park, FL, United States
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An Z, Lei T, Duan L, Hu P, Gou Z, Zhang L, Durand-Gasselin L, Wang N, Wang Y, Gu F. Efficacy and safety of lanreotide autogel compared with lanreotide 40 mg prolonged release in Chinese patients with active acromegaly: results from a phase 3, prospective, randomized, and open-label study (LANTERN). BMC Endocr Disord 2020; 20:57. [PMID: 32366244 PMCID: PMC7199333 DOI: 10.1186/s12902-020-0524-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 03/23/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Lanreotide autogel is a somatostatin analog (SSA) approved for the treatment of acromegaly in 73 countries worldwide; however, it is not yet approved in China. The aim of this study was to evaluate the efficacy and safety of lanreotide autogel compared with lanreotide 40 mg prolonged release (PR) in Chinese patients with active acromegaly. METHODS LANTERN was a phase 3, randomized, open-label, non-inferiority study. Patients with active acromegaly who had undergone surgery ≥3 months prior, or were unlikely or unable to undergo surgery, were treated with lanreotide autogel 60/90/120 mg (monthly deep subcutaneous injection) or lanreotide 40 mg PR (intramuscular injection every 7, 10, or 14 days) for 32 weeks. Primary endpoint was mean change-from-baseline in age-adjusted insulin-like growth factor-1 (IGF-1) standard deviation scores (SDS) at the end-of-study. Secondary endpoints included: growth hormone (GH) levels ≤2.5 μg/L or ≤ 1.0 μg/L, ≥20% reduction in tumor volume (TV) and safety. RESULTS In total, 128 patients were randomized and received study treatment. Lanreotide autogel was non-inferior to lanreotide 40 mg PR: treatment difference (95% CI) for IGF-1 SDS between groups was - 0.32 (- 0.74, 0.11; per protocol population) and - 0.27 (- 0.63, 0.09; intention-to-treat [ITT] population), respectively. Reductions in IGF-1 (- 6.453 vs - 7.003) and GH levels (- 9.548 μg/L vs - 13.182 μg/L), and the proportion of patients with ≥1 acromegaly symptom (- 20.3% vs - 32.5%) were observed from baseline to end-of-study in lanreotide autogel and lanreotide 40 mg PR groups, respectively. In the lanreotide autogel group, 45.5% (25/55) patients achieved ≥20% reduction in TV compared with 50.9% (25/53) in lanreotide 40 mg PR group (ITT). Safety profiles were similar in both treatment groups. CONCLUSIONS Lanreotide autogel was non-inferior to lanreotide 40 mg PR in Chinese patients with active acromegaly after 32 weeks of treatment. TRIAL REGISTRATION Retrospectively registered on ClinicalTrials.gov: NCT02493517 (9 July 2015); prospectively registered on chinadrugtrials.org.cn: CTR20140698 (24 October 2014).
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Affiliation(s)
- Zhenmei An
- West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ting Lei
- Tongji Hospital, Tongji Medical college of HUST, Wuhan, China
| | - Lian Duan
- Peking Union Medical College Hospital, PUMCH, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Pei Hu
- Peking Union Medical College Hospital, PUMCH, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Zhongping Gou
- West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lihui Zhang
- The second hospital of Hebei Medical University, Shijiazhuang, China
| | | | | | | | - Feng Gu
- Peking Union Medical College Hospital, PUMCH, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China.
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Dastamani A, Güemes M, Pitfield C, Morgan K, Rajab M, Rottenburger C, Bomanji J, De Coppi P, Dattani M, Shah P. The Use of a Long-Acting Somatostatin Analogue (Lanreotide) in Three Children with Focal Forms of Congenital Hyperinsulinaemic Hypoglycaemia. Horm Res Paediatr 2019; 91:56-61. [PMID: 30114684 DOI: 10.1159/000491101] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 06/19/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND A long-acting somatostatin analogue (lanreotide) is used in the management of a diazoxide-unresponsive diffuse form of congenital hyperinsulinism (CHI). However, no reports of its use in patients with the focal form of CHI exist. Case 1: A 1-month-old boy diagnosed with diazoxide-unresponsive CHI due to a paternal heterozygous ABCC8 gene mutation showed partial response to octreotide. 18F-DOPA-PET/CT scan revealed a focal lesion in the pancreatic head. Surgical removal of the lesion was unsuccessful. He was switched to monthly lanreotide treatment at the age of 11 months, which stabilised his blood glucose over a 12-month period. Case 2: A 1-month-old boy with diazoxide-unresponsive CHI due to a paternal heterozygous KCNJ11 gene mutation was partially responsive to octreotide. 18F-DOPA-PET/CT scan confirmed a focal pancreatic head lesion. Over 6 months, he underwent 3 lesionectomies and afterwards responded to octreotide. At the age of 9 months, treatment was switched to monthly lanreotide. Currently, he is aged 3, with stable glycaemia, and improved fasting tolerance. Case 3: A 3-week-old girl with a paternal heterozygous ABCC8 gene mutation was unresponsive to diazoxide. 18F-DOPA-PET/CT scan confirmed a focal pancreatic head lesion. She responded to octreotide, and her parents preferred to avoid pancreatic surgery. At the age of 20 months, treatment was switched to monthly lanreotide, resulting in euglycaemia over the last 7 months. CONCLUSION CHI patients with focal pancreatic head lesions are challenging, especially if not surgically amenable. Conservative treatment is preferable, and lanreotide might be an option. The therapeutic impact of lanreotide treatment in patients with the focal forms of CHI should be confirmed in prospective studies with close monitoring of the side effects.
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Affiliation(s)
- Antonia Dastamani
- Endocrinology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Maria Güemes
- Endocrinology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,Genetics and Genomic Medicine Programme, Genetics and Epigenetics in Health and Disease Section, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Catherine Pitfield
- Endocrinology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Kate Morgan
- Endocrinology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Mansoor Rajab
- Salmaniya Medical Complex, Arabian Gulf University, Manama, Bahrain
| | - Christof Rottenburger
- Department of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Jamshed Bomanji
- Department of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Paolo De Coppi
- Department of Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Mehul Dattani
- Endocrinology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,Genetics and Genomic Medicine Programme, Genetics and Epigenetics in Health and Disease Section, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Pratik Shah
- Endocrinology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom, .,Genetics and Genomic Medicine Programme, Genetics and Epigenetics in Health and Disease Section, UCL Great Ormond Street Institute of Child Health, London, United Kingdom,
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Biological and Biochemical Basis of the Differential Efficacy of First and Second Generation Somatostatin Receptor Ligands in Neuroendocrine Neoplasms. Int J Mol Sci 2019; 20:ijms20163940. [PMID: 31412614 PMCID: PMC6720449 DOI: 10.3390/ijms20163940] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/1970] [Revised: 08/05/2019] [Accepted: 08/08/2019] [Indexed: 02/07/2023] Open
Abstract
Endogenous somatostatin shows anti-secretory effects in both physiological and pathological settings, as well as inhibitory activity on cell growth. Since somatostatin is not suitable for clinical practice, researchers developed synthetic somatostatin receptor ligands (SRLs) to overcome this limitation. Currently, SRLs represent pivotal tools in the treatment algorithm of neuroendocrine tumors (NETs). Octreotide and lanreotide are the first-generation SRLs developed and show a preferential binding affinity to somatostatin receptor (SST) subtype 2, while pasireotide, which is a second-generation SRL, has high affinity for multiple SSTs (SST5 > SST2 > SST3 > SST1). A number of studies demonstrated that first-generation and second-generation SRLs show distinct functional properties, besides the mere receptor affinity. Therefore, the aim of the present review is to critically review the current evidence on the biological effects of SRLs in pituitary adenomas and neuroendocrine tumors, by mainly focusing on the differences between first-generation and second-generation ligands.
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Torniai M, Scortichini L, Tronconi F, Rubini C, Morgese F, Rinaldi S, Mazzanti P, Berardi R. Systemic treatment for lung carcinoids: from bench to bedside. Clin Transl Med 2019; 8:22. [PMID: 31273555 PMCID: PMC6609661 DOI: 10.1186/s40169-019-0238-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 06/21/2019] [Indexed: 12/13/2022] Open
Abstract
In the huge spectrum of lung neuroendocrine neoplasms, typical and atypical carcinoids should be considered as a separate biological entity from poorly differentiated forms, harboring peculiar molecular alterations. Despite their indolent behavior, lung carcinoids correlate with a worse survival. To date, only limited therapeutic options are available and novel drugs are strongly needed. In this work, we extensively reviewed scientific literature exploring available therapeutic options, new molecular targets and future perspectives in the management of well differentiated neoplasms of bronchopulmonary tree. Systemic therapy represents the main option in advanced and unresectable disease; accepted choices are somatostatin analogs, peptide receptor radionuclide therapy, everolimus and chemotherapy. To date, an univocal treatment strategy has not been identified yet, thus tailored therapeutic algorithms should consider treatment efficacy as well as safety profiles. Several molecular alterations found in carcinoid tumors might act as molecular targets leading to development of new therapeutic options. Further studies are necessary to identify new potential “druggable” molecular targets in the selected subset of low-grade lung carcinoids. Furthermore, evaluating the available therapies in more homogeneous population might improve their efficacy through a perfect tailoring of treatment options.
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Affiliation(s)
- Mariangela Torniai
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Via Conca 71, 60126, Ancona, Italy
| | - Laura Scortichini
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Via Conca 71, 60126, Ancona, Italy
| | - Francesca Tronconi
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Via Conca 71, 60126, Ancona, Italy
| | - Corrado Rubini
- Section of Pathological Anatomy and Histopathology, Department of Neuroscience, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - Francesca Morgese
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Via Conca 71, 60126, Ancona, Italy
| | - Silvia Rinaldi
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Via Conca 71, 60126, Ancona, Italy
| | - Paola Mazzanti
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Via Conca 71, 60126, Ancona, Italy
| | - Rossana Berardi
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Via Conca 71, 60126, Ancona, Italy.
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Abreu C, Guinto G, Mercado M. Surgical-pharmacological interactions in the treatment of acromegaly. Expert Rev Endocrinol Metab 2019; 14:35-42. [PMID: 30595057 DOI: 10.1080/17446651.2019.1559729] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 12/13/2018] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Acromegaly requires a multimodal treatment approach that includes surgery by an expert pituitary neurosurgeon, pharmacological treatment with one or more of the available drugs and radiation therapy. These treatment alternatives are not mutually exclusive but rather complement each other when properly indicated in the individual patient. In this review, we summarize and analyze the available data concerning the choice of the surgical approach (microscopy vs. endoscopy) and the interactions between medical treatment with somatostatin analogs and pituitary surgery. AREAS COVERED Technical aspects, complications and outcome of transsphenoidal surgery (TSS); Advantages and disadvantages of the microscopic and endoscopic approaches; Safety and efficacy of somatostatin analogs (SSA); Primary pharmacological therapy versus primary TSS; Benefits of the preoperative treatment with SSA; and the effect of surgical tumor debulking in the therapeutic response to SSA. EXPERT COMMENTARY Continuing efforts at improving surgical techniques and at generating more efficacious pharmacological therapies for acromegaly are likely to improve the outcome of these patients. However, an integral approach of the patient aimed not only at achieving biochemical criteria of cure but also at treating the individual comorbidities is mandatory to improve the quality of life of these patients and to reduce their mortality rate.
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Affiliation(s)
- Coralys Abreu
- a Endocrinology Service , Centro Medico Nacional 20 de Noviembre, ISSSTE , Mexico City , Mexico
| | - Gerardo Guinto
- b Neurological Center , American British Cowdray Medical Center , Mexico City , Mexico
| | - Moisés Mercado
- c Experimental Endocrinology Unit , Hospital de Especialidades, Centro Medico Nacional S. XXI, IMSS , Mexico City , Mexico
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Godara A, Siddiqui NS, Byrne MM, Saif MW. The safety of lanreotide for neuroendocrine tumor. Expert Opin Drug Saf 2018; 18:1-10. [PMID: 30582380 DOI: 10.1080/14740338.2019.1559294] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Lanreotide autogel is a synthetic somatostatin analogue which has been FDA and EMA approved for unresectable, well to moderately differentiated, locally advanced or metastatic gastroenteropancreatic neuroendocrine tumor. Its action is mediated by its affinity to somatostatin receptors, especially sst2 and sst5 receptors. Its longer half-life offers the convenience of 4-week dosing over the need for frequent injections of short-acting somatostatin analogues. Areas covered: Lanreotide ATG offers progression-free survival benefit in locally advanced or metastatic neuroendocrine tumor (NET) compared to placebo, reflecting a strong antiproliferative signal. As lanreotide is commonly used for management of NET, it is imperative to recognize and appropriately manage any drug-related toxicities. In this review, we will provide an overview of the toxicity with lanreotide and its management. Expert opinion: Lanreotide is highly effective in managing carcinoid symptoms and has a robust anti-tumor effect in NET. Overall, it is well tolerated with low rates of treatment discontinuation due to toxicity. It's toxicity profile is mostly predictable, and patients should be informed of the transient nature of some of the upfront toxicities.
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Affiliation(s)
- Amandeep Godara
- a Gastrointestinal Oncology Program and Experimental therapeutics, Division of Hematology/Oncology , Tufts Medical Center - Tufts University School of Medicine , Boston , MA , USA
| | - Nauman S Siddiqui
- a Gastrointestinal Oncology Program and Experimental therapeutics, Division of Hematology/Oncology , Tufts Medical Center - Tufts University School of Medicine , Boston , MA , USA
| | - Margaret M Byrne
- a Gastrointestinal Oncology Program and Experimental therapeutics, Division of Hematology/Oncology , Tufts Medical Center - Tufts University School of Medicine , Boston , MA , USA
| | - Muhammad Wasif Saif
- a Gastrointestinal Oncology Program and Experimental therapeutics, Division of Hematology/Oncology , Tufts Medical Center - Tufts University School of Medicine , Boston , MA , USA
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14
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Kafal AR, Vinh DC, Langelier MJ. Prefilled syringes for immunoglobulin G (IgG) replacement therapy: clinical experience from other disease settings. Expert Opin Drug Deliv 2018; 15:1199-1209. [DOI: 10.1080/17425247.2018.1546692] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Ayman R. Kafal
- Medical Affairs, CSL Behring LLC, King of Prussia, PA, USA
| | - Donald C. Vinh
- Infectious Disease Susceptibility Program, Research Institute – McGill University Health Centre, Montreal, Quebec, Canada
| | - Mélanie J. Langelier
- Infectious Disease Susceptibility Program, Research Institute – McGill University Health Centre, Montreal, Quebec, Canada
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15
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Kumar Nagarajan S, Babu S, Sohn H, Devaraju P, Madhavan T. Toward a better understanding of the interaction between somatostatin receptor 2 and its ligands: a structural characterization study using molecular dynamics and conceptual density functional theory. J Biomol Struct Dyn 2018; 37:3081-3102. [PMID: 30079808 DOI: 10.1080/07391102.2018.1508368] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This study is a part of the extensive research intending to provide the structural insights on somatostatin and its receptor. Herein, we have studied the structural complexity involved in the binding of somatostatin receptor 2 (SSTR2) with its agonists and antagonist. A 3D QSAR study based on comparative molecular field analysis and comparative molecular similarity analysis (CoMSIA) discerned that a SSTR2 ligand with electronegative, less-bulkier, and hydrogen atom donating/accepting substitutions is important for their biological activity. A conceptual density functional theory (DFT) study was followed to study the chemical behavior of the ligands based on the molecular descriptors derived using the Fukui's molecular orbital theory. We have performed molecular dynamics simulations of receptor-ligand complexes for 100 ns to analyze the dynamic stability of the backbone Cα atoms of the receptor and strength and approachability of the receptor-ligand complex. The findings of this study could be efficacious in the further studies understanding intricate structural features of the somatostatin receptors and in discovering novel subtype-specific ligands with higher affinity. Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Santhosh Kumar Nagarajan
- a Department of Genetic Engineering School of Bioengineering , SRM Institute of Science and Technology , Kattankulathur, Chennai , India
| | - Sathya Babu
- a Department of Genetic Engineering School of Bioengineering , SRM Institute of Science and Technology , Kattankulathur, Chennai , India
| | - Honglae Sohn
- b Department of Chemistry and Department of Carbon Materials , Chosun University , Gwangju , South Korea
| | - Panneer Devaraju
- c Division of Microbiology and Molecular Biology , Vector Control Research Centre, Indian Council of Medical Research , Pondicherry , India
| | - Thirumurthy Madhavan
- a Department of Genetic Engineering School of Bioengineering , SRM Institute of Science and Technology , Kattankulathur, Chennai , India
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16
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17
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Improving long-term subcutaneous drug delivery by regulating material-bioenvironment interaction. Adv Drug Deliv Rev 2018; 127:20-34. [PMID: 29391221 DOI: 10.1016/j.addr.2018.01.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 01/22/2018] [Accepted: 01/24/2018] [Indexed: 02/08/2023]
Abstract
Subcutaneous long-acting release (LAR) formulations have been extensively developed in the clinic to increase patient compliance and reduce treatment cost. Despite preliminary success for some LAR systems, a major obstacle limiting the therapeutic effect remains on their interaction with surrounding tissues. In this review, we summarize how living bodies respond to injected or implanted materials, and highlight some typical strategies based on smart material design, which may significantly improve long-term subcutaneous drug delivery. Moreover, possible strategies to achieve ultra-long (months, years) subcutaneous drug delivery systems are proposed. Based on these discussions, we believe the well-designed subcutaneous long-acting formulations will hold great promise to improve patient quality of life in the clinic.
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18
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Khan M, Huang T, Lin CY, Wu J, Fan BM, Bian ZX. Exploiting cancer's phenotypic guise against itself: targeting ectopically expressed peptide G-protein coupled receptors for lung cancer therapy. Oncotarget 2017; 8:104615-104637. [PMID: 29262666 PMCID: PMC5732832 DOI: 10.18632/oncotarget.18403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 05/23/2017] [Indexed: 02/07/2023] Open
Abstract
Lung cancer, claiming millions of lives annually, has the highest mortality rate worldwide. This advocates the development of novel cancer therapies that are highly toxic for cancer cells but negligibly toxic for healthy cells. One of the effective treatments is targeting overexpressed surface receptors of cancer cells with receptor-specific drugs. The receptors-in-focus in the current review are the G-protein coupled receptors (GPCRs), which are often overexpressed in various types of tumors. The peptide subfamily of GPCRs is the pivot of the current article owing to the high affinity and specificity to and of their cognate peptide ligands, and the proven efficacy of peptide-based therapeutics. The article summarizes various ectopically expressed peptide GPCRs in lung cancer, namely, Cholecystokinin-B/Gastrin receptor, the Bombesin receptor family, Bradykinin B1 and B2 receptors, Arginine vasopressin receptors 1a, 1b and 2, and the Somatostatin receptor type 2. The autocrine growth and pro-proliferative pathways they mediate, and the distinct tumor-inhibitory effects of somatostatin receptors are then discussed. The next section covers how these pathways may be influenced or 'corrected' through therapeutics (involving agonists and antagonists) targeting the overexpressed peptide GPCRs. The review proceeds on to Nano-scaled delivery platforms, which enclose chemotherapeutic agents and are decorated with peptide ligands on their external surface, as an effective means of targeting cancer cells. We conclude that targeting these overexpressed peptide GPCRs is potentially evolving as a highly promising form of lung cancer therapy.
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Affiliation(s)
- Mahjabin Khan
- Laboratory of Brain-Gut Research, School of Chinese Medicine, Hong Kong Baptist University, HKSAR, Kowloon Tong, P.R. China
| | - Tao Huang
- Laboratory of Brain-Gut Research, School of Chinese Medicine, Hong Kong Baptist University, HKSAR, Kowloon Tong, P.R. China
| | - Cheng-Yuan Lin
- Laboratory of Brain-Gut Research, School of Chinese Medicine, Hong Kong Baptist University, HKSAR, Kowloon Tong, P.R. China
- YMU-HKBU Joint Laboratory of Traditional Natural Medicine, Yunnan Minzu University, Kunming, P.R. China
| | - Jiang Wu
- State Key Laboratory of Applied Organic Chemistry, College of Chemistry and Chemical Engineering, Lanzhou University, Lanzhou, P. R. China
| | - Bao-Min Fan
- YMU-HKBU Joint Laboratory of Traditional Natural Medicine, Yunnan Minzu University, Kunming, P.R. China
| | - Zhao-Xiang Bian
- Laboratory of Brain-Gut Research, School of Chinese Medicine, Hong Kong Baptist University, HKSAR, Kowloon Tong, P.R. China
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19
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Theoretical analysis of somatostatin receptor 5 with antagonists and agonists for the treatment of neuroendocrine tumors. Mol Divers 2017. [PMID: 28155055 DOI: 10.1007/s11030‐016‐9722‐7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We report on SSTR5 receptor modeling and its interaction with reported antagonist and agonist molecules. Modeling of the SSTR5 receptor was carried out using multiple templates with the aim of improving the precision of the generated models. The selective SSTR5 antagonists, agonists and native somatostatin SRIF-14 were employed to propose the binding site of SSTR5 and to identify the critical residues involved in the interaction of the receptor with other molecules. Residues Q2.63, D3.32, Q3.36, C186, Y7.34 and Y7.42 were found to be highly significant for their strong interaction with the receptor. SSTR5 antagonists were utilized to perform a 3D quantitative structure-activity relationship study. A comparative molecular field analysis (CoMFA) was conducted using two different alignment schemes, namely the ligand-based and receptor-based alignment methods. The best statistical results were obtained for ligand-based ([Formula: see text], [Formula: see text] = 0.988, noc = 4) and receptor-guided methods (docked mode 1:[Formula: see text], [Formula: see text], noc = 5), (docked mode 2:[Formula: see text] = 0.555, [Formula: see text], noc = 5). Based on CoMFA contour maps, an electropositive substitution at [Formula: see text], [Formula: see text] and [Formula: see text] position and bulky group at [Formula: see text] position are important in enhancing molecular activity.
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20
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Theoretical analysis of somatostatin receptor 5 with antagonists and agonists for the treatment of neuroendocrine tumors. Mol Divers 2017; 21:367-384. [PMID: 28155055 DOI: 10.1007/s11030-016-9722-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 12/30/2016] [Indexed: 10/20/2022]
Abstract
We report on SSTR5 receptor modeling and its interaction with reported antagonist and agonist molecules. Modeling of the SSTR5 receptor was carried out using multiple templates with the aim of improving the precision of the generated models. The selective SSTR5 antagonists, agonists and native somatostatin SRIF-14 were employed to propose the binding site of SSTR5 and to identify the critical residues involved in the interaction of the receptor with other molecules. Residues Q2.63, D3.32, Q3.36, C186, Y7.34 and Y7.42 were found to be highly significant for their strong interaction with the receptor. SSTR5 antagonists were utilized to perform a 3D quantitative structure-activity relationship study. A comparative molecular field analysis (CoMFA) was conducted using two different alignment schemes, namely the ligand-based and receptor-based alignment methods. The best statistical results were obtained for ligand-based ([Formula: see text], [Formula: see text] = 0.988, noc = 4) and receptor-guided methods (docked mode 1:[Formula: see text], [Formula: see text], noc = 5), (docked mode 2:[Formula: see text] = 0.555, [Formula: see text], noc = 5). Based on CoMFA contour maps, an electropositive substitution at [Formula: see text], [Formula: see text] and [Formula: see text] position and bulky group at [Formula: see text] position are important in enhancing molecular activity.
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21
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Massironi S, Conte D, Rossi RE. Somatostatin analogues in functioning gastroenteropancreatic neuroendocrine tumours: literature review, clinical recommendations and schedules. Scand J Gastroenterol 2016; 51:513-23. [PMID: 26605828 DOI: 10.3109/00365521.2015.1115117] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Neuroendocrine tumours (NETs) represent a heterogeneous group of neoplasms, which include functioning and non-functioning forms. Somatostatin analogues (SSAs) play a key role in the management of these tumours. Herein, we aimed at reviewing the current evidence about the role of SSAs in the treatment of gastro-entero-pancreatic (GEP)-NETs. MATERIAL AND METHODS An extensive bibliographical search was performed in PubMed using the following keywords: gastro-entero-pancreatic neuroendocrine tumours, somatostatin analogues, octreotide, lanreotide, in order to identify all the pertinent English-written articles published between 1990 and 2015. RESULTS SSAs have shown to help the symptomatic and biochemical improvement of patients with NETs and to exhibit a good safety profile. Recent studies have also reported a role for SSAs in tumour growth control, although the results are less impressive and the underlying mechanisms are not fully understood. CONCLUSIONS SSAs are well known as a symptomatic and, to lesser extent, anti-proliferative treatment in GEP-NETs. However, some issues, including optimal dosage, benefits and adverse events of combination with other molecules, and the role of new analogues, remain to be elucidated in further randomised studies.
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Affiliation(s)
- Sara Massironi
- a Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - Dario Conte
- a Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy ;,b Department of Pathophysiology and Transplantation , Università Degli Studi Di Milano , Milan , Italy
| | - Roberta Elisa Rossi
- a Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy ;,b Department of Pathophysiology and Transplantation , Università Degli Studi Di Milano , Milan , Italy
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22
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Pokuri VK, Fong MK, Iyer R. Octreotide and Lanreotide in Gastroenteropancreatic Neuroendocrine Tumors. Curr Oncol Rep 2016; 18:7. [PMID: 26743514 DOI: 10.1007/s11912-015-0492-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Neuroendocrine tumors are heterogeneous, rare malignancies that arise most commonly in the gastrointestinal tract and pancreas. They often secrete vasoactive substances resulting in carcinoid syndrome and the tumor cells exclusively express somatostatin receptors. Octreotide and lanreotide are the two synthetic somatostatin analogs used for the control of carcinoid symptoms and tumor progression in advanced inoperable disease. Recent pivotal trials (PROMID and CLARINET studies) established their antitumor activity. We discuss the available data to support their use as symptom controlling and antiproliferative agents. This article also reviews the guidelines (National Comprehensive Cancer Network and North American Neuro Endocrine Tumor Society), cost-analysis (suggesting the cost-effectiveness of lanreotide autogel compared to higher doses of octreotide long acting release formulation in refractory patients), and future directions of somatostatin analogs in the management of patients refractory to conventional doses of octreotide and lanreotide.
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Affiliation(s)
- Venkata K Pokuri
- Department of Medical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Mei Ka Fong
- Department of Pharmacy, Carolinas Healthcare System, Levine Cancer Institute, Charlotte, NC, USA
| | - Renuka Iyer
- Department of Medical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA.
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23
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Strasburger CJ, Karavitaki N, Störmann S, Trainer PJ, Kreitschmann-Andermahr I, Droste M, Korbonits M, Feldmann B, Zopf K, Sanderson VF, Schwicker D, Gelbaum D, Haviv A, Bidlingmaier M, Biermasz NR. Patient-reported outcomes of parenteral somatostatin analogue injections in 195 patients with acromegaly. Eur J Endocrinol 2016; 174:355-62. [PMID: 26744896 PMCID: PMC4722610 DOI: 10.1530/eje-15-1042] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 12/17/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND Long-acting somatostatin analogues delivered parenterally are the most widely used medical treatment in acromegaly. This patient-reported outcomes survey was designed to assess the impact of chronic injections on subjects with acromegaly. METHODS The survey was conducted in nine pituitary centres in Germany, UK and The Netherlands. The questionnaire was developed by endocrinologists and covered aspects of acromegaly symptoms, injection-related manifestations, emotional and daily life impact, treatment satisfaction and unmet medical needs. RESULTS In total, 195 patients participated, of which 112 (57%) were on octreotide (Sandostatin LAR) and 83 (43%) on lanreotide (Somatuline Depot). The majority (>70%) of patients reported acromegaly symptoms despite treatment. A total of 52% of patients reported that their symptoms worsen towards the end of the dosing interval. Administration site pain lasting up to a week following injection was the most frequently reported injection-related symptom (70% of patients). Other injection site reactions included nodules (38%), swelling (28%), bruising (16%), scar tissue (8%) and inflammation (7%). Injection burden was similar between octreotide and lanreotide. Only a minority of patients received injections at home (17%) and 5% were self-injecting. Over a third of patients indicated a feeling of loss of independence due to the injections, and 16% reported repeated work loss days. Despite the physical, emotional and daily life impact of injections, patients were satisfied with their treatment, yet reported that modifications that would offer major improvement over current care would be 'avoiding injections' and 'better symptom control'. CONCLUSION Lifelong injections of long-acting somatostatin analogues have significant burden on the functioning, well-being and daily lives of patients with acromegaly.
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Affiliation(s)
- Christian J Strasburger
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - Niki Karavitaki
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - Sylvère Störmann
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - Peter J Trainer
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - Ilonka Kreitschmann-Andermahr
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - Michael Droste
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - Márta Korbonits
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - Berit Feldmann
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - Kathrin Zopf
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - Violet Fazal Sanderson
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - David Schwicker
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - Dana Gelbaum
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - Asi Haviv
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - Martin Bidlingmaier
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - Nienke R Biermasz
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
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Du X, Zhou J, Shi J, Xu B. Supramolecular Hydrogelators and Hydrogels: From Soft Matter to Molecular Biomaterials. Chem Rev 2015; 115:13165-307. [PMID: 26646318 PMCID: PMC4936198 DOI: 10.1021/acs.chemrev.5b00299] [Citation(s) in RCA: 1278] [Impact Index Per Article: 142.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Indexed: 12/19/2022]
Abstract
In this review we intend to provide a relatively comprehensive summary of the work of supramolecular hydrogelators after 2004 and to put emphasis particularly on the applications of supramolecular hydrogels/hydrogelators as molecular biomaterials. After a brief introduction of methods for generating supramolecular hydrogels, we discuss supramolecular hydrogelators on the basis of their categories, such as small organic molecules, coordination complexes, peptides, nucleobases, and saccharides. Following molecular design, we focus on various potential applications of supramolecular hydrogels as molecular biomaterials, classified by their applications in cell cultures, tissue engineering, cell behavior, imaging, and unique applications of hydrogelators. Particularly, we discuss the applications of supramolecular hydrogelators after they form supramolecular assemblies but prior to reaching the critical gelation concentration because this subject is less explored but may hold equally great promise for helping address fundamental questions about the mechanisms or the consequences of the self-assembly of molecules, including low molecular weight ones. Finally, we provide a perspective on supramolecular hydrogelators. We hope that this review will serve as an updated introduction and reference for researchers who are interested in exploring supramolecular hydrogelators as molecular biomaterials for addressing the societal needs at various frontiers.
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Affiliation(s)
- Xuewen Du
- Department of Chemistry, Brandeis University, 415 South Street, Waltham, Massachusetts 02454, United States
| | - Jie Zhou
- Department of Chemistry, Brandeis University, 415 South Street, Waltham, Massachusetts 02454, United States
| | - Junfeng Shi
- Department of Chemistry, Brandeis University, 415 South Street, Waltham, Massachusetts 02454, United States
| | - Bing Xu
- Department of Chemistry, Brandeis University, 415 South Street, Waltham, Massachusetts 02454, United States
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Lanreotide Autogel® in acromegaly: a guide to its use in the EU. DRUGS & THERAPY PERSPECTIVES 2015. [DOI: 10.1007/s40267-015-0257-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
PURPOSE The Acromegaly Consensus Group recently released updated guidelines for medical management of acromegaly patients. We subjected these guidelines to a cost analysis. METHODS We conducted a cost analysis of the recommendations based on published efficacy rates as well as publicly available cost data. The results were compared to findings from a previously reported comparative effectiveness analysis of acromegaly treatments. Using decision tree software, two models were created based on the Acromegaly Consensus Group's recommendations and the comparative effectiveness analysis. The decision tree for the Consensus Group's recommendations was subjected to multi-way tornado analysis to identify variables that most impacted the value analysis of the decision tree. RESULTS The value analysis confirmed the Consensus Group's recommendations of somatostatin analogs as first line therapy for medical management. Our model also demonstrated significant value in using dopamine agonist agents as upfront therapy as well. Sensitivity analysis identified the cost of somatostatin analogs and growth hormone receptor antagonists as having the most significant impact on the cost effectiveness of medical therapies. CONCLUSION Our analysis confirmed the value of surgery as first-line therapy for patients with surgically accessible lesions. Surgery provides the greatest value for management of patients with acromegaly. However, in accordance with the Acromegaly Consensus Group's recent recommendations, somatostatin analogs provide the greatest value and should be used as first-line therapy for patients who cannot be managed surgically. At present, the substantial cost is the most significant negative factor in the value of medical therapies for acromegaly.
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Affiliation(s)
- Kristopher T Kimmell
- The Department of Neurosurgery, University of Rochester Medical Center, 601 Elmwood Avenue, Box 670, Rochester, NY, 14642, USA,
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Abstract
Being driven by non-covalent interactions, the formation of functional assemblies (or aggregates) of small molecules at nanoscale is a more common process in water than one would think. While most efforts on self-assembly in cellular environment concentrate on the assemblies of proteins (e.g., microtubules or amyloid fibers), nanoscale assemblies of small molecules are emerging functional entities that exhibit important biological function in cellular environments. This review describes the increasing efforts on the exploration of nanoscale assemblies of small molecules that largely originate from the serendipitous observations in research fields other than nanoscience and technology. Specifically, we describe that nanoscale assemblies of small molecules exhibit unique biological functions in extracellular and intracellular environment, thus inducing various cellular responses, like causing cell death or promoting cell proliferation. We first survey certain common feature of nanoscale molecular assemblies, then discuss several specific examples, such as, nanoscale assemblies of small peptides accumulated in the cells for selectively inhibiting cancer cells via promiscuous interactions with proteins, and nanoscale assemblies of a glycoconjugate for promoting the proliferation of stem cells or for suppressing immune responses. Subsequently, we emphasize the spatiotemporal control of nanoscale assemblies for controlling the cell fate, particularly illustrate a paradigm-shifting approach-enzyme-instructed self-assembly (EISA), that is, the integration of enzymatic reaction and self-assembly-for generating nanoscale assemblies from innocuous monomers for selectively inhibiting cancer cells. Moreover, we introduce a convenient assay for proteomic study of the proteins that interact with nanoscale assemblies of small molecules in cellular environment. Furthermore, we introduce the use of ligand-receptor interaction to catalyze the formation of nanoscale assemblies. By illustrating these experimental strategies for controlling the formation of nanoscale assemblies of small molecules and for identifying their corresponding protein targets, we aim to highlight that, though not being defined at the genetic level, nanoscale assemblies of small molecules are able to perform many critical biological functions. We envision that nanoscale assemblies of small molecules are a new frontier at the intersection of nanoscience and cell biology and biomedicine. In addition, we discuss the challenges and perspectives of relevant potential biomedical applications of nanoscale assemblies of small molecules.
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Affiliation(s)
- Junfeng Shi
- Department of Chemistry, Brandeis University, 415 South St. MS 015, Waltham, MA 02454
| | - Bing Xu
- Department of Chemistry, Brandeis University, 415 South St. MS 015, Waltham, MA 02454
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Grasso LFS, Auriemma RS, Pivonello R, Colao A. Adverse events associated with somatostatin analogs in acromegaly. Expert Opin Drug Saf 2015; 14:1213-26. [DOI: 10.1517/14740338.2015.1059817] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Kyriakakis N, Chau V, Lynch J, Orme SM, Murray RD. Lanreotide autogel in acromegaly - a decade on. Expert Opin Pharmacother 2014; 15:2681-92. [PMID: 25307803 DOI: 10.1517/14656566.2014.970173] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The novel formulation of lanreotide, lanreotide (LAN) autogel (ATG), has been available in Europe since 2001 and USA from 2006 for the treatment of acromegaly. It is one of only two clinically available somatostatin analogs available for use in acromegaly. Data relating to the use of ATG in acromegaly, specifically relating to comparison to octreotide (OCT) LAR and patient acceptability and preference, have been slow to accumulate. AREAS COVERED We performed a comprehensive review of the original literature relating to development, pharmacokinetics, acceptability and clinical efficacy of ATG. EXPERT OPINION LAN ATG is a novel formulation of LAN consequent on self-assembly of nanotubules in water. Diffusion between molecules within the nanotubules and surrounding tissue fluid in vivo leads to pseudo first-order pharmacokinetics. Efficacy is equivalent to the alternate long-acting somatostatin analog, OCT LAR, normalizing growth hormone and IGF-I levels in around 60 and 50% respectively. Control of tumor growth is observed in over 95% of patients, with 64% seeing a clinically significant reduction in tumor size. ATG is provided in a prefilled syringe for deep subcutaneous injection, allowing self-injection, and may be administered up to 8 weeks greatly improving convenience for the patient. The data strongly support consideration of ATG as the medical therapy of choice for patients with acromegaly.
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Affiliation(s)
- Nikolaos Kyriakakis
- St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds Centre for Diabetes and Endocrinology, Department of Endocrinology , Beckett Street, Leeds LS9 7TF , UK +44 0 113 206 4578 ; +44 0 113 206 5065 ;
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Burness CB, Dhillon S, Keam SJ. Lanreotide Autogel®: A Review of its Use in the Treatment of Patients with Acromegaly. Drugs 2014; 74:1673-91. [DOI: 10.1007/s40265-014-0283-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Stone JC, Clark J, Cuneo R, Russell AW, Doi SAR. Estrogen and selective estrogen receptor modulators (SERMs) for the treatment of acromegaly: a meta-analysis of published observational studies. Pituitary 2014; 17:284-95. [PMID: 23925896 DOI: 10.1007/s11102-013-0504-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Estrogen and selective estrogen receptor modulator (SERM) treatments for acromegaly have received limited attention since the development of newer pharmacologic therapies. There has been ongoing research evidence suggesting their utility in the biochemical control of acromegaly. Therefore, the aim of this meta-analysis was to synthesise current evidence with a view to determining to what extent and in which acromegalic patient subsets do estrogen and SERMs reduce IGF-1 levels. A literature search was conducted (finished December 2012), which included all studies pertaining to estrogen or SERM treatment and IGF-1. Seven patient subsets were identified from six published observational studies, and were pooled using meta-analytic methods. Overall, the pooled mean loss in IGF-1 was -29.09 nmol/L (95 % CI -37.23 to -20.95). A sensitivity analysis indicated that women receiving estrogen had a substantially greater reduction in IGF-1 levels compared with women receiving SERMs, with a weighted mean loss in IGF-1 of -38.12 nmol/L (95 % CI -46.78 to -29.45) compared with -22.91 nmol/L (95 % CI -32.73 to -13.09). There was a trend that did not reach statistical significance for men receiving SERM treatment at -11.41 nmol/L (95 % CI -30.14 to 7.31). It was concluded that estrogen and SERMs are a low cost and effective treatment to achieve control of IGF-1 levels in acromegalic women either as concomitant treatment for refractory disease, or where access to conventional therapy is restricted. Their use in men requires further study.
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Affiliation(s)
- Jennifer C Stone
- Clinical Epidemiology Unit, School of Population Health, University of Queensland, Brisbane, QLD, Australia
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Wu D, Zhou J, Shi J, Du X, Xu B. A naphthalene-containing amino acid enables hydrogelation of a conjugate of nucleobase-saccharide-amino acids. Chem Commun (Camb) 2014; 50:1992-4. [PMID: 24412974 PMCID: PMC3974899 DOI: 10.1039/c3cc48946a] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Here we report the first example of a hydrogelator made of a conjugate of nucleobase-saccharide-amino acids by incorporating L-3-(2-naphthyl)-alanine to the conjugate, which illustrates a facile and effective method for generating bioactive and functional hydrogelators from the basic biological building blocks.
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Affiliation(s)
- Dongdong Wu
- Department of Chemistry, Brandeis University, 415 South St., Waltham, MA 02454, USA.
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Öberg K. Somatostatin analog octreotide LAR®in gastro–entero–pancreatic tumors. Expert Rev Anticancer Ther 2014; 9:557-66. [DOI: 10.1586/era.09.26] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Wang JW, Li Y, Mao ZG, Hu B, Jiang XB, Song BB, Wang X, Zhu YH, Wang HJ. Clinical applications of somatostatin analogs for growth hormone-secreting pituitary adenomas. Patient Prefer Adherence 2014; 8:43-51. [PMID: 24421637 PMCID: PMC3888346 DOI: 10.2147/ppa.s53930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Excessive growth hormone (GH) is usually secreted by GH-secreting pituitary adenomas and causes gigantism in juveniles or acromegaly in adults. The clinical complications involving cardiovascular, respiratory, and metabolic systems lead to elevated morbidity in acromegaly. Control of serum GH and insulin-like growth factor (IGF) 1 hypersecretion by surgery or pharmacotherapy can decrease morbidity. Current pharmacotherapy includes somatostatin analogs (SAs) and GH receptor antagonist; the former consists of lanreotide Autogel (ATG) and octreotide long-acting release (LAR), and the latter refers to pegvisomant. As primary medical therapy, lanreotide ATG and octreotide LAR can be supplied in a long-lasting formulation to achieve biochemical control of GH and IGF-1 by subcutaneous injection every 4-6 weeks. Lanreotide ATG and octreotide LAR provide an effective medical treatment, whether as a primary or secondary therapy, for the treatment of GH-secreting pituitary adenoma; however, to maximize benefits with the least cost, several points should be emphasized before the application of SAs. A comprehensive assessment, especially of the observation of clinical predictors and preselection of SA treatment, should be completed in advance. A treatment process lasting at least 3 months should be implemented to achieve a long-term stable blood concentration. More satisfactory surgical outcomes for noninvasive macroadenomas treated with presurgical SA may be achieved, although controversy of such adjuvant therapy exists. Combination of SA and pegvisomant or cabergoline shows advantages in some specific cases. Thus, an individual treatment program should be established for each patient under a full evaluation of the risks and benefits.
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Affiliation(s)
- Ji-wen Wang
- Department of Neurosurgery and Pituitary Tumor Center, The First Affiliated Hospital, Sun Yat-sen University, People’s Republic of China
- Key Laboratory of Pituitary Adenoma in Guangdong Province, People’s Republic of China
| | - Ying Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, People’s Republic of China
| | - Zhi-gang Mao
- Department of Neurosurgery and Pituitary Tumor Center, The First Affiliated Hospital, Sun Yat-sen University, People’s Republic of China
- Key Laboratory of Pituitary Adenoma in Guangdong Province, People’s Republic of China
| | - Bin Hu
- Department of Neurosurgery and Pituitary Tumor Center, The First Affiliated Hospital, Sun Yat-sen University, People’s Republic of China
- Key Laboratory of Pituitary Adenoma in Guangdong Province, People’s Republic of China
| | - Xiao-bing Jiang
- Department of Neurosurgery and Pituitary Tumor Center, The First Affiliated Hospital, Sun Yat-sen University, People’s Republic of China
- Key Laboratory of Pituitary Adenoma in Guangdong Province, People’s Republic of China
| | - Bing-bing Song
- Department of Histology and Embryology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Xin Wang
- Department of Histology and Embryology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Yong-hong Zhu
- Department of Histology and Embryology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, People’s Republic of China
- Yong-hong Zhu, Department of Histology and Embryology, Zhongshan School of Medicine, Sun Yat-sen University, No. 74, Zhongshan Road 2, Guangzhou 510080, People’s Republic of China, Email
| | - Hai-jun Wang
- Department of Neurosurgery and Pituitary Tumor Center, The First Affiliated Hospital, Sun Yat-sen University, People’s Republic of China
- Key Laboratory of Pituitary Adenoma in Guangdong Province, People’s Republic of China
- Correspondence: Hai-jun Wang; Department of Neurosurgery and Pituitary Tumor Center, The First Affiliated Hospital, Sun Yat-sen University, No 58, Zhongshan Road 2, Guangzhou 510080, People’s Republic of China, Email
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Wilson TJ, McKean EL, Barkan AL, Chandler WF, Sullivan SE. Repeat endoscopic transsphenoidal surgery for acromegaly: remission and complications. Pituitary 2013; 16:459-64. [PMID: 23307479 DOI: 10.1007/s11102-012-0457-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Reported biochemical remission rates following surgical intervention for acromegaly range from 38 to 83%. In patients not achieving surgical remission, few options remain, mostly limited to medical management and radiation therapy. There is debate over whether or not to offer reoperation to patients in whom surgical remission is not achieved with initial resection. Retrospective chart review was undertaken to determine all patients having acromegaly with persistently elevated GH and/or IGF-1 levels after initial pituitary adenoma resection, and who underwent reoperation using endoscopic endonasal approach at a single institution. Biochemical remission was defined as a postoperative GH level <1 ng/mL and a normal postoperative IGF-1 level in the absence of any medical therapy. In total, 14 patients underwent repeat surgical intervention for acromegaly via endoscopic transsphenoidal approach. Of the 14 patients, 8 (57%) achieved biochemical remission following repeat surgical intervention. Lower preoperative GH levels were associated with greater chance of biochemical remission (P = 0.048). New endocrinopathies were seen in 2 patients (14%), and both were transient diabetes insipidus. Meningitis occurred in 2 patients (14%); both were aseptic meningitis with no sequelae. No mortality was encountered. Repeat surgical intervention for acromegaly via endoscopic transsphenoidal approach appears safe and effective. With no mortality and minimal morbidity, repeat surgical intervention via endoscopic transsphenoidal approach appears a reasonable option for these hard-to-treat patients and should be considered for patients in whom surgical remission is not achieved with initial surgery.
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Affiliation(s)
- Thomas J Wilson
- Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Drive, Room 3552 TC, Ann Arbor, MI, 48109-5338, USA
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Toumpanakis C, Caplin ME. Update on the role of somatostatin analogs for the treatment of patients with gastroenteropancreatic neuroendocrine tumors. Semin Oncol 2013; 40:56-68. [PMID: 23391113 DOI: 10.1053/j.seminoncol.2012.11.006] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Somatostatin analogs (SA) are the standard of care for controlling symptoms of patients with functional gastro-entero-pancreatic neuroendocrine tumors (GEP-NETs). SA control symptoms in more than 70% of patients with carcinoid syndrome. Similar results are obtained in patients with functional, hormone-secreting, pancreatic NETs. The use of SA as antiproliferative agents has been established only recently. Retrospective studies have shown stabilization of tumor growth in >50% of patients with progressive disease. The results of a recent randomized phase III trial (PROMID) demonstrated that the median time to progression in patients with midgut carcinoid tumors treated with octreotide LAR (Long-Acting-Repeatable, Novartis, Basel, Switzerland) was more than twice as long compared to that of patients treated with placebo. The results of a phase III study of lanreotide versus placebo in nonfunctional NETs are not yet available. More studies are needed to determine whether combining SA with novel targeted treatments will result in enhanced antiproliferative activity compared to treatment with a SA alone. Studies are ongoing using pan-receptor agonists (eg, pasireotide) and chimeric dimers, which possess features of somatostatin and dopamine agonists (dopastatins) and are thought to enhance symptom control by binding multiple receptors (somatostatin and dopamine receptors). Somatostatin receptor antagonists are also currently being developed for clinical use. Peptide receptor radionuclide therapy (PRRT), consisting of yttrium-90 and lutetium-177 isotopes conjugated with SA appear to be efficacious in advanced NETs. Randomized studies are needed to definitively establish the safety and efficacy of this strategy compared to other available treatments, and to determine which radiolabeled isotopes or combinations are most effective.
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Affiliation(s)
- Christos Toumpanakis
- Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital, London, UK
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Shimatsu A, Teramoto A, Hizuka N, Kitai K, Ramis J, Chihara K. Efficacy, safety, and pharmacokinetics of sustained-release lanreotide (lanreotide Autogel) in Japanese patients with acromegaly or pituitary gigantism. Endocr J 2013; 60:651-63. [PMID: 23337477 DOI: 10.1507/endocrj.ej12-0417] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The somatostatin analog lanreotide Autogel has proven to be efficacious for treating acromegaly in international studies and in clinical practices around the world. However, its efficacy in Japanese patients has not been extensively evaluated. We examined the dose-response relationship and long-term efficacy and safety in Japanese patients with acromegaly or pituitary gigantism. In an open-label, parallel-group, dose-response study, 32 patients (29 with acromegaly, 3 with pituitary gigantism) received 5 injections of 60, 90, or 120 mg of lanreotide Autogel over 24 weeks. Four weeks after the first injection, 41% of patients achieved serum GH level of <2.5 ng/mL and insulin-like growth factor-I (IGF-I) level was normalized in 31%. Values at Week 24 were 53% for GH and 44% for IGF-I. Dose-dependent decreases in serum GH and IGF-I levels were observed with dose-related changes in pharmacokinetic parameters. In an open-label, long-term study, 32 patients (30 with acromegaly, 2 with pituitary gigantism) received lanreotide Autogel once every 4 weeks for a total of 13 injections. Dosing was initiated with 90 mg and adjusted according to clinical responses at Weeks 16 and/or 32. At Week 52, 47% of patients had serum GH levels of <2.5 ng/mL and 53% had normalized IGF-I level. In both studies, acromegaly symptoms improved and treatment was generally well tolerated although gastrointestinal symptoms and injection site induration were reported. In conclusion, lanreotide Autogel provided early and sustained control of elevated GH and IGF-I levels, improved acromegaly symptoms, and was well tolerated in Japanese patients with acromegaly or pituitary gigantism.
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Affiliation(s)
- Akira Shimatsu
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan.
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Li J, Kuang Y, Gao Y, Du X, Shi J, Xu B. D-amino acids boost the selectivity and confer supramolecular hydrogels of a nonsteroidal anti-inflammatory drug (NSAID). J Am Chem Soc 2012; 135:542-5. [PMID: 23136972 DOI: 10.1021/ja310019x] [Citation(s) in RCA: 229] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
As systemically used therapeutics for treating acute or chronic pains or inflammations, nonsteroidal anti-inflammatory drugs (NSAIDs) also associate with the adverse gastrointestinal and renal effects and cardiovascular risks. Thus, it is beneficial to develop topical gels that selectively inhibit cyclooxygenase-2 (COX-2) for the management of local inflammation. In this work, we demonstrate that the covalent conjugation of d-amino acids to naproxen (i.e., a NSAID) not only affords supramolecular hydrogelators for the topical gels but also unexpectedly and significantly elevates the selectivity toward COX-2 about 20× at little expense of the activity of naproxen. This work illustrates a previously unexplored approach that employs d-amino acids for the development of functional molecules that have dual or multiple roles and exceptional biostability, which offers a new class of molecular hydrogels of therapeutic agents.
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Affiliation(s)
- Jiayang Li
- Department of Chemistry, Brandeis University, 415 South St., Waltham, Massachusetts 02454, USA
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Gao Y, Long M, Shi J, Hedstrom L, Xu B. Using supramolecular hydrogels to discover the interactions between proteins and molecular nanofibers of small molecules. Chem Commun (Camb) 2012; 48:8404-6. [PMID: 22801479 PMCID: PMC3728678 DOI: 10.1039/c2cc33631f] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Here we report the first example of the use of supramolecular hydrogels to discover the protein targets of aggregates of small molecules.
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Affiliation(s)
- Yuan Gao
- Department of Chemistry, Brandeis University, 415 South Street, Waltham, MA 02453, USA. Fax: 78 1736 2516; Tel: 78 1736 5201
| | - Marcus Long
- Department of Biology, Brandeis University, 415 South Street, Waltham, MA 02453, USA. Fax: 78 1736 2516; Tel: 78 1736 5201
| | - Junfeng Shi
- Department of Chemistry, Brandeis University, 415 South Street, Waltham, MA 02453, USA. Fax: 78 1736 2516; Tel: 78 1736 5201
| | - Lizbeth Hedstrom
- Department of Chemistry, Brandeis University, 415 South Street, Waltham, MA 02453, USA. Fax: 78 1736 2516; Tel: 78 1736 5201
- Department of Biology, Brandeis University, 415 South Street, Waltham, MA 02453, USA. Fax: 78 1736 2516; Tel: 78 1736 5201
| | - Bing Xu
- Department of Chemistry, Brandeis University, 415 South Street, Waltham, MA 02453, USA. Fax: 78 1736 2516; Tel: 78 1736 5201
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40
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Abstract
This article presents management options for the patient with acromegaly after noncurative surgery. The current evidence for repeat surgery, adjuvant medical therapy with somatostatin analogues, dopamine agonists, the growth hormone receptor antagonist pegvisomant, combination medical therapy, and radiotherapy in the context of persistent postoperative disease are summarized. The relative advantages and disadvantages of each of these treatment modalities are explored, and a general treatment algorithm that integrates these modalities is proposed.
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Affiliation(s)
- Nestoras Mathioudakis
- Johns Hopkins University School of Medicine, Division of Endocrinology & Metabolism, Department of Medicine, Baltimore, MD 21287, USA
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41
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Grasso LFS, Pivonello R, Colao A. Somatostatin analogs as a first-line treatment in acromegaly: when is it appropriate? Curr Opin Endocrinol Diabetes Obes 2012; 19:288-94. [PMID: 22627686 DOI: 10.1097/med.0b013e328354af67] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW To discuss the role of medical therapy of acromegaly as a first-line treatment, focusing on recent data on the use of somatostatin analogs (SSAs), the first-choice pharmacotherapy for treating acromegaly. RECENT FINDINGS Despite pituitary surgery and radiotherapy, a significant number of patients with acromegaly needed adjuvant medical therapy, and primary medical therapy nowadays is increasingly considered. According to a recent consensus statement on the management of acromegaly, primary pharmacological therapy with SSAs may be indicated in patients who are otherwise poor surgical candidates or refuse surgery, and in those in whom there is a low probability of a surgical cure. The long-acting SSAs have been found to be effective in improving symptoms and signs of acromegaly in a high percentage of patients and induce normalization of growth hormone and insulin-like growth factor-I levels approximately in 60-80% of patients, respectively. Evidence has suggested that SSAs induce a clinically significant tumor shrinkage when given as first-line, when this reduction of tumor volume could be helpful in improving the outcome of subsequent surgery or improving the clinical syndrome in patients with unacceptable surgical risk, whereas the tumor shrinkage was seen less frequently when the drug was used after surgical resection and/or radiotherapy. SUMMARY Pharmacological management plays a pivotal role in the treatment of acromegaly, and first-line medical therapy with SSAs is being widely used in clinical practice, either prior to surgery or in patients who are otherwise poor surgical candidates and in those in whom there is a low probability of a surgical cure.
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Affiliation(s)
- Ludovica F S Grasso
- Department of Clinical and Molecular Endocrinology and Oncology, Federico II University of Naples, Naples, Italy
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42
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Carmichael JD. Lanreotide depot deep subcutaneous injection: a new method of delivery and its associated benefits. Patient Prefer Adherence 2012; 6:73-82. [PMID: 22298946 PMCID: PMC3269320 DOI: 10.2147/ppa.s20783] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Acromegaly is a rare disease characterized by excessive growth hormone secretion, usually from a pituitary tumor. Treatment options include surgery, medical therapy, and in some cases, radiation therapy. Current medical therapy consists of treatment with somatostatin analog medications or a growth hormone receptor antagonist. There are two somatostatin analogs currently in use, octreotide and lanreotide. Both are supplied in long-acting formulations and are of comparable biochemical efficacy. Lanreotide is supplied in a prefilled syringe and is injected into deep subcutaneous tissue. Studies have been conducted to assess the efficacy of self- or partner administration, and have demonstrated that injection of lanreotide can be accomplished reliably and safely outside a physician's office. For patients who have achieved biochemical control with lanreotide, the FDA has recently approved an extended dosing interval. Selected patients may be able to receive the medication less frequently with injections of 120 mg administered every 6 or 8 weeks. This review focuses on the use of lanreotide in the treatment of acromegaly, the safety and efficacy of the drug, and the benefits afforded to patients because of unique aspects of the delivery of lanreotide.
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Affiliation(s)
- John D Carmichael
- Correspondence: John D Carmichael, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA, Tel +1 310 423 2830, Fax +1 310 423 2819, Email
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Modan-Moses D, Koren I, Mazor-Aronovitch K, Pinhas-Hamiel O, Landau H. Treatment of congenital hyperinsulinism with lanreotide acetate (Somatuline Autogel). J Clin Endocrinol Metab 2011; 96:2312-7. [PMID: 21697252 DOI: 10.1210/jc.2011-0605] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
CONTEXT Congenital hyperinsulinism (CH) may be treated conservatively in many children with octreotide given by multiple sc injections or via an insulin pump. OBJECTIVE We describe two children treated with a once-monthly injection of a long-acting somatostatin analog. PATIENTS AND METHODS Both patients presented with hypoglycemia 30 min after birth and were subsequently diagnosed with CH. Patients were initially treated with diazoxide, hydrochlorothiazide, frequent feedings, and octreotide via an insulin pump. With this therapy, they were normoglycemic with a good growth rate, normal weight gain, and excellent neurodevelopment. Treatment with the long-acting somatostatin analog lanreotide acetate (Somatuline Autogel), administered by deep sc injection of 30 mg once a month, was started at the ages of 4½ and 4 yr, respectively. Octreotide infusion was gradually weaned over 1 month. Continuous glucose monitoring after discontinuation of pump therapy showed normoglycemia. The first patient has now been treated with the lanreotide acetate for over 5 yr, and the second for 3 yr. Treatment is well-tolerated, and both the patients and their parents are satisfied with the transition from pump therapy to once-a-month injection and prefer it to pump therapy. CONCLUSION Lanreotide acetate may be a safe and effective alternative to octreotide pump therapy in patients with CH, offering an improved quality of life. Longer follow-up of a larger patient group is needed.
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Affiliation(s)
- Dalit Modan-Moses
- Pediatric Endocrinology and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel-Hashomer (affiliated with The Sackler School of Medicine, Tel-Aviv University), 52621 Israel.
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Fleseriu M. Clinical efficacy and safety results for dose escalation of somatostatin receptor ligands in patients with acromegaly: a literature review. Pituitary 2011; 14:184-93. [PMID: 21161602 PMCID: PMC3094533 DOI: 10.1007/s11102-010-0282-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Acromegaly is a rare disease with a multifaceted clinical presentation. In 90-95% of patients with acromegaly, the disease is caused by a growth hormone (GH)-secreting pituitary adenoma with elevated GH levels that ultimately induce excessive hepatic secretion of insulin-like growth factor-1 (IGF-1). Somatostatin receptor ligands (SRLs) are considered the standard medical choice for the treatment of acromegaly, and normalization of GH and IGF-1 is attainable with effective therapy. This review aims to summarize the literature relative to SRL dose escalation therapy in patients with acromegaly. A United States National Library of Medicine PubMed search of SRL's was conducted using the following search terms: ((((LAR) OR ATG) OR octreotide) OR lanreotide Autogel) AND acromegaly. Related articles in non peer-reviewed journals were excluded. The rationale and benefits of SRL dose optimization therapy were investigated with emphasis on describing the clinical recognition, treatment, and management of patients with acromegaly. We found that dose escalation could provide additional biochemical control of acromegaly in patients who are inadequately controlled with conventional starting doses of octreotide LAR and lanreotide Autogel(®). Furthermore, patients should routinely have their GH and IGF-1 levels closely monitored and their SRL dose increased or decreased thereafter according to individual response.
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Affiliation(s)
- Maria Fleseriu
- Department of Neurological Surgery, Northwest Pituitary Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, (BTE 472), Portland, OR 97239, USA.
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Abstract
Acromegaly is a rare disease characterized by excess secretion of growth hormone (GH) and increased circulating insulin-like growth factor 1 (IGF-1) concentrations. The disease is associated with increased morbidity and premature mortality, but these effects can be reduced if GH levels are decreased to <2.5 μg/l and IGF-1 levels are normalized. Therapy for acromegaly is targeted at decreasing GH and IGF-1 levels, ameliorating patients' symptoms and decreasing any local compressive effects of the pituitary adenoma. The therapeutic options for acromegaly include surgery, radiotherapy and medical therapies, such as dopamine agonists, somatostatin receptor ligands and the GH receptor antagonist pegvisomant. Medical therapy is currently most widely used as secondary treatment for persistent or recurrent acromegaly following noncurative surgery, although it is increasingly used as primary therapy. This Review provides an overview of current and future pharmacological therapies for patients with acromegaly.
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Affiliation(s)
- Mark Sherlock
- Centre for Endocrinology Diabetes and Metabolism, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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Advances in the therapy of gastroenteropancreatic-neuroendocrine tumours (GEP-NETs). Clin Transl Oncol 2010; 12:481-92. [PMID: 20615825 DOI: 10.1007/s12094-010-0541-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Neuroendocrine tumours (NET) of the digestive tract comprise a broad range of malignancies. The therapeutic approach to these tumours has not evolved as it did in other tumour types in the last two decades. The deeper knowledge of the underlying molecular biology behind the growth of neuroendocrine cells has brought much information to light. We now know that somatostatin analogues may not only be considered as symptomatic treatment but also as antitumour agents. Sunitinib, a tyrosine kinase (TK) inhibitor with antiangiogenic and antitumoural properties, has been shown to induce significant improvement in progression-free survival in a randomised trial conducted in well-differentiated pancreatic islet-cell NETs. The relevance of the phosphatidylinositol 3-kinase/protein kinase B/mammalian target of rapamycin (PI3K/Akt/mTOR) pathway seems to be crucial in gastroenteropancreatic (GEP)-NETs. In fact, mTOR inhibitors have shown activity in uncontrolled trials, and large, randomised trial results will be available shortly. In this article, we summarise the most recent available data on medical therapy for GEPNETs.
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Salvatori R, Nachtigall LB, Cook DM, Bonert V, Molitch ME, Blethen S, Chang S. Effectiveness of self- or partner-administration of an extended-release aqueous-gel formulation of lanreotide in lanreotide-naïve patients with acromegaly. Pituitary 2010; 13:115-22. [PMID: 19898989 PMCID: PMC2855862 DOI: 10.1007/s11102-009-0207-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Surgical resection is often not curative in patients with acromegaly and long-acting somatostatin analogues (lanreotide or octreotide) are often needed. This study assessed the efficacy and safety of self- or partner-administration of lanreotide in patients with acromegaly. This was a six-month, single-arm, open-label study conducted at 13 endocrinology clinics. Fifty-nine patients received deep subcutaneous lanreotide injections every 28 days. Twelve patients started on 120 mg lanreotide and forty-seven started on 90 mg lanreotide. At week 16, the dose was adjusted to 60, 90 or 120 mg based on insulin-like growth factor-1 (IGF-1) levels at week 12. Fifty-nine patients with acromegaly either switched from long-acting octreotide (switch; n = 33) or were somatostatin analogue treatment-naïve or not currently taking long-acting octreotide ("other"; n = 26). The key endpoints included the percentage of patients/partners able to self- or partner-inject lanreotide and those with normal IGF-1 or growth hormone (GH) levels at week 24/early termination. 100% of patients/partners correctly self- (n = 41) or partner-injected (n = 18) lanreotide by week 4. By week 24/early termination, IGF-1 levels were controlled in 93.7% of switch and 46.2% of "other" patients, while GH levels were controlled in 76.9% and 39.1% of patients, respectively. Both IGF-1 and GH were controlled in 73.1% of switch and 30.4% of "other" patients. Most switch patients (81%) reported they preferred lanreotide over long-acting octreotide for future use (P = 0.0001). Self- or partner-administration of lanreotide is generally well tolerated and associated with IGF-1 and GH control in many lanreotide-naïve patients with acromegaly.
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Affiliation(s)
- Roberto Salvatori
- Division of Endocrinology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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Biller BMK, Colao A, Petersenn S, Bonert VS, Boscaro M. Prolactinomas, Cushing's disease and acromegaly: debating the role of medical therapy for secretory pituitary adenomas. BMC Endocr Disord 2010; 10:10. [PMID: 20478050 PMCID: PMC2887860 DOI: 10.1186/1472-6823-10-10] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Accepted: 05/17/2010] [Indexed: 01/22/2023] Open
Abstract
Pituitary adenomas are associated with a variety of clinical manifestations resulting from excessive hormone secretion and tumor mass effects, and require a multidisciplinary management approach. This article discusses the treatment modalities for the management of patients with a prolactinoma, Cushing's disease and acromegaly, and summarizes the options for medical therapy in these patients.First-line treatment of prolactinomas is pharmacotherapy with dopamine agonists; recent reports of cardiac valve abnormalities associated with this class of medication in Parkinson's disease has prompted study in hyperprolactinemic populations. Patients with resistance to dopamine agonists may require other treatment.First-line treatment of Cushing's disease is pituitary surgery by a surgeon with experience in this condition. Current medical options for Cushing's disease block adrenal cortisol production, but do not treat the underlying disease. Pituitary-directed medical therapies are now being explored. In several small studies, the dopamine agonist cabergoline normalized urinary free cortisol in some patients. The multi-receptor targeted somatostatin analogue pasireotide (SOM230) shows promise as a pituitary-directed medical therapy in Cushing's disease; further studies will determine its efficacy and safety. Radiation therapy, with medical adrenal blockade while awaiting the effects of radiation, and bilateral adrenalectomy remain standard treatment options for patients not cured with pituitary surgery.In patients with acromegaly, surgery remains the first-line treatment option when the tumor is likely to be completely resected, or for debulking, especially when the tumor is compressing neurovisual structures. Primary therapy with somatostatin analogues has been used in some patients with large extrasellar tumors not amenable to surgical cure, patients at high surgical risk and patients who decline surgery. Pegvisomant is indicated in patients who have not responded to surgery and other medical therapy, although there are regional differences in when it is prescribed.In conclusion, the treatment of patients with pituitary adenomas requires a multidisciplinary approach. Dopamine agonists are an effective first-line medical therapy in most patients with a prolactinoma, and somatostatin analogues can be used as first-line therapy in selected patients with acromegaly. Current medical therapies for Cushing's disease primarily focus on adrenal blockade of cortisol production, although pasireotide and cabergoline show promise as pituitary-directed medical therapy for Cushing's disease; further long-term evaluation of efficacy and safety is important.
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Affiliation(s)
- Beverly MK Biller
- Neuroendocrine Clinical Center, Massachusetts General Hospital, Boston, USA
| | - Annamaria Colao
- Dipartimento di Endocrinologia ed Oncologia Molecolare e Clinica, Università degli Studi di Napoli Federico II, Napoli, Italy
| | - Stephan Petersenn
- Division of Endocrinology, University of Duisburg-Essen, Essen, Germany
| | - Vivien S Bonert
- Department of Medicine, Cedars-Sinai Medical Center, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Marco Boscaro
- Division of Endocrinology, Institute of Internal Medicine, Polytechnic University of Marche, Ancona, Italy
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Melmed S, Cook D, Schopohl J, Goth MI, Lam KSL, Marek J. Rapid and sustained reduction of serum growth hormone and insulin-like growth factor-1 in patients with acromegaly receiving lanreotide Autogel therapy: a randomized, placebo-controlled, multicenter study with a 52 week open extension. Pituitary 2010; 13:18-28. [PMID: 19639415 PMCID: PMC2807598 DOI: 10.1007/s11102-009-0191-1] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Accepted: 06/29/2009] [Indexed: 11/05/2022]
Abstract
The study was designed to evaluate the long-term efficacy and safety of the 28-day prolonged-release Autogel formulation of the somatostatin analogue lanreotide (Lan-Autogel) in unselected patients with acromegaly. The study comprised four phases: washout; a double-blind comparison with placebo, at a single randomized dose (60, 90 or 120 mg) of Lan-Autogel; a single-blind, fixed-dose phase for four injections (placebo group was re-allocated to active treatment); and eight injections with doses tailored according to biochemical response. Serum samples were assessed for growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels, at weeks 4, 13, 14, 15, 16, 32 and 52. 108 patients were enrolled and 99 completed 52 weeks' treatment. Four weeks after the first injection, serum GH levels decreased by >50% from baseline in 63% of patients receiving Lan-Autogel compared with 0% receiving placebo (P < 0.001). After four injections, 72% of patients had a >50% reduction in GH levels; 49% patients achieved GH levels < or = 2.5 ng/ml; 54% had normalized IGF-1; and 38% achieved the combined criterion of GH level < or = 2.5 ng/ml and normalized IGF-1. The corresponding proportions by week 52 were 82, 54, 59 and 43%, respectively. In patients not requiring dose escalation to 120 mg, 85% achieved biochemical control (combined criterion). Treatment was well tolerated by all patients. In conclusion, Lan-Autogel was effective in controlling GH and IGF-1 hypersecretion in patients with acromegaly and showed a rapid onset of action.
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Affiliation(s)
- Shlomo Melmed
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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