Objective: Effect of Sandostatin (SAS) on growth rate of pituitary tumours secreting growth hormone. Open, controlled, multicentre study.
Subjects: 78 pat. SAS group: 39 pat., 14 men and 25 women, mean age 40.9 years. Control group: 39 pat., 14 men and 25 women, mean age 41.4 years.
Indications: acromegaly and pituitary adenoma secreting growth hormone (39)
Dosage/Duration: 0.2 mg daily to 0.9 mg daily (mean 0.356 mg daily) as s.c.injection. Duration: 2 to 62 months, mean 12.1 months.
Free Text: Tests: Ki-67 labelling index, apoptotic index, serum growth hormone (GH) and insulin like growth factor 1 (IGF-1), tumour size on MRI scan. Additional therapy: surgery. Pat. in the SAS group received SAS until the day of surgery or the day before surgery. Pat. in the control group were matched to pat. in the SAS group for sex, age, tumour size, extension and invasiveness. During SAS therapy, GH decreased from mean 38.7 to 19.1 mcg/l (p<0.001, data available for 34 pat.). Suppression of GH was >50% in 22/34 pat. and reached <2.5 mcg/l in 6 pat. IGF-1 decreased from mean 924.1 to 45 mcg/l (p<0.001, data available for 17 pat.). Tumour shrinkage of at least 20% occurred in 5/25 pat. who had MRI scans before and after SAS therapy.
Results: Tumour samples from pat. in the SAS group showed signif. lower Ki-67 labelling index than those from controls (p<0.02). Overall, mean Ki-67 labelling index was 53% lower in the SAS group vs. controls. Antiproliferative effect of SAS occurred independently of tumour extension and invasiveness. Ki-67 labelling index in the SAS group was not correlated with dose or duration of SAS therapy, but was signif. lower in pat. who achieved GH <2.5 mcg/l than in pat. who did not and in pat. who had tumour shrinkage vs. pat. who did not. Apoptotic index was similar in both groups of tumour samples (mean 0.6 in the SAS group, 0.8 in controls). There was a positive correlation between Ki-67 labelling index and apoptotic index (p<0.03).
Author(s) Conclusion: Acromegalic patients receiving chronic octreotide treatment have a lower value of the proliferation marker Ki-67, but no significant difference in the apoptotic index compared with matched untreated patients. The antiproliferative effect of octreotide on GH-secreting adenomas should imply a lower risk of tumor growth during long-term chronic treatment with the drug.
Number of Cases: 39

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