Personalized Medical Treatment of Patients With Acromegaly: A Review

Acromegaly is associated with significant morbidity and mortality if it is not appropriately treated. In addition to insulin-like growth factor 1 and growth hormone normalization as well as tumor shrinkage, the treatment goals include relieving symptoms, managing complications, and improving patients' quality of life. Surgical resection is a first-line treatment option for most patients, with few being pretreated preoperatively with medications. Somatostatin receptor ligands (SRLs), injectable and, more recently, oral capsules, have been the cornerstone of first-line medical therapy for persistent disease. However, several factors, including sparsely granulated adenomas, absent or low somatostatin receptor status, T2-hyperintensity imaging, young age, and aryl hydrocarbon receptor-interacting protein mutations, can predict first-generation SRL resistance. Patients with these characteristics may be better candidates for the growth hormone receptor antagonist pegvisomant, or in cases of large tumors, the second-generation SRL pasireotide. Combination therapy should be further pursued in patients who remain biochemically uncontrolled or have a high remnant tumor after monotherapy. An efficacious and cost-effective pegvisomant dose-sparing effect of SRLs when used in combination has been demonstrated. With such a wide array of medical treatment options, it is becoming increasingly important to tailor treatment to patients' unique characteristics and preferences, with a goal of personalizing management to achieve high-quality outcomes. (c) 2022 AACE. Published by Elsevier Inc. All rights reserved.

Automated summary

Acromegaly is a condition that requires appropriate treatment to prevent significant morbidity and mortality. The treatment goals include normalization of insulin-like growth factor 1 and growth hormone, tumor shrinkage, symptom relief, complication management, and improvement of quality of life. Surgical resection is the first-line treatment option, and somatostatin receptor ligands (SRLs) are commonly used for medical therapy. However, SRL resistance can be predicted by certain factors, and alternative treatments such as growth hormone receptor antagonists or second-generation SRLs may be considered. Combination therapy can be pursued for patients who are not biochemically controlled or have residual tumor after monotherapy. Personalized management based on individual characteristics and preferences is important for achieving high-quality outcomes.