Efficacy and predictors of response to somatostatin analogues in patients with ectopic ACTH syndrome
Aim. To study the immediate efficacy, tolerability and predictors of response to prolonged-acting somatostatin analogues (SSAs) in patients with ectopic ACTH syndrome (EAS). Materials and methods. A multicenter, observational study with a retrospective analysis. The effectiveness of treatment was...
Saved in:
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | Russian |
| Published: |
"Consilium Medicum" Publishing house
2024-12-01
|
| Series: | Терапевтический архив |
| Subjects: | |
| Online Access: | https://ter-arkhiv.ru/0040-3660/article/viewFile/631985/pdf |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832592279003463680 |
|---|---|
| author | Olga O. Golounina Zhanna E. Belaya Alla A. Markovich Liudmila Y. Rozhinskaya Galina A. Mel`nichenko Natalia G. Mokrysheva Ivan I. Dedov |
| author_facet | Olga O. Golounina Zhanna E. Belaya Alla A. Markovich Liudmila Y. Rozhinskaya Galina A. Mel`nichenko Natalia G. Mokrysheva Ivan I. Dedov |
| author_sort | Olga O. Golounina |
| collection | DOAJ |
| description | Aim. To study the immediate efficacy, tolerability and predictors of response to prolonged-acting somatostatin analogues (SSAs) in patients with ectopic ACTH syndrome (EAS).
Materials and methods. A multicenter, observational study with a retrospective analysis. The effectiveness of treatment was evaluated every 12–24 weeks by the activity of hypercortisolism, clinical symptoms of the disease, control of tumor growth. Patients were conditionally divided into “responders” and “non-responders” at time points of 6, 12 and 24 months. Radiological efficacy was performed according to the RECIST 1.1. Statistical data processing was carried out by using IBM SPSS Statistics 23.
Results. The study included 46 patients (26 women, 20 men). The median follow-up period was 71 months [32; 122]. Localized tumor process (T1-3N0M0) – in 19 (41.3%) patients, locally widespread (T1-3N1M0, T4N0-1M0) – in 15 (32.6%), generalized (T1-4N0-1M1) – in 12 (26.1%) cases. Surgical treatment was performed in 33 (71.7%) patients. SSAs were the first-line therapy for all 46 patients. The average duration of SSAs use was 34 months (Me 27.5 [13.8; 41]). Dose escalation was required in 39.4% cases, the period before the first dose escalation was on average 9 months. 13 (48.1%) patients achieved drug-induced remission of the disease. Normalization of cortisol in 24hUFC or its decrease ≥50% from the baseline level by the 6th month of treatment was achieved in 46.4%, by the 12th month – in 61.9%, “eluding” from the effect of therapy was observed in 3 patients. Objective response was evaluated in 30 patients. There was no complete response to the treatment. In 4 (13.3%) cases – a partial response, in 15 (50%) – disease stabilization, in 11 (36.7%) – disease progression. The best therapeutic efficacy of SSAs is associated with bronchial NET (HR 0.078, 95% CI 0.010–0.633; p=0.017), and resistance to treatment is associated with negative expression of SSTR5 (HR 6.532, 95% CI 1.019–41.878; p=0.048).
Conclusion. SSAs are the drugs of choice for the first-line treatment of patients with EAS, allowing for long-term effective control of hypercortisolism and tumor progression in more than 60% of patients. Significant factors determining the response to SSAs after 6 months of treatment are expression status of SSTR5 and NET localization. |
| format | Article |
| id | doaj-art-44406a3ae8e74a7d956b80cb97263b8c |
| institution | Kabale University |
| issn | 0040-3660 2309-5342 |
| language | Russian |
| publishDate | 2024-12-01 |
| publisher | "Consilium Medicum" Publishing house |
| record_format | Article |
| series | Терапевтический архив |
| spelling | doaj-art-44406a3ae8e74a7d956b80cb97263b8c2025-01-21T11:09:17Zrus"Consilium Medicum" Publishing houseТерапевтический архив0040-36602309-53422024-12-01961093294110.26442/00403660.2024.10.20285678561Efficacy and predictors of response to somatostatin analogues in patients with ectopic ACTH syndromeOlga O. Golounina0https://orcid.org/0000-0003-2320-1051Zhanna E. Belaya1https://orcid.org/0000-0002-6674-6441Alla A. Markovich2https://orcid.org/0000-0002-5548-1724Liudmila Y. Rozhinskaya3https://orcid.org/0000-0001-7041-0732Galina A. Mel`nichenko4https://orcid.org/0000-0002-5634-7877Natalia G. Mokrysheva5https://orcid.org/0000-0002-9717-9742Ivan I. Dedov6https://orcid.org/0000-0002-8175-7886Endocrinology Research CentreEndocrinology Research CentreBlokhin National Medical Research Center of OncologyEndocrinology Research CentreEndocrinology Research CentreEndocrinology Research CentreEndocrinology Research CentreAim. To study the immediate efficacy, tolerability and predictors of response to prolonged-acting somatostatin analogues (SSAs) in patients with ectopic ACTH syndrome (EAS). Materials and methods. A multicenter, observational study with a retrospective analysis. The effectiveness of treatment was evaluated every 12–24 weeks by the activity of hypercortisolism, clinical symptoms of the disease, control of tumor growth. Patients were conditionally divided into “responders” and “non-responders” at time points of 6, 12 and 24 months. Radiological efficacy was performed according to the RECIST 1.1. Statistical data processing was carried out by using IBM SPSS Statistics 23. Results. The study included 46 patients (26 women, 20 men). The median follow-up period was 71 months [32; 122]. Localized tumor process (T1-3N0M0) – in 19 (41.3%) patients, locally widespread (T1-3N1M0, T4N0-1M0) – in 15 (32.6%), generalized (T1-4N0-1M1) – in 12 (26.1%) cases. Surgical treatment was performed in 33 (71.7%) patients. SSAs were the first-line therapy for all 46 patients. The average duration of SSAs use was 34 months (Me 27.5 [13.8; 41]). Dose escalation was required in 39.4% cases, the period before the first dose escalation was on average 9 months. 13 (48.1%) patients achieved drug-induced remission of the disease. Normalization of cortisol in 24hUFC or its decrease ≥50% from the baseline level by the 6th month of treatment was achieved in 46.4%, by the 12th month – in 61.9%, “eluding” from the effect of therapy was observed in 3 patients. Objective response was evaluated in 30 patients. There was no complete response to the treatment. In 4 (13.3%) cases – a partial response, in 15 (50%) – disease stabilization, in 11 (36.7%) – disease progression. The best therapeutic efficacy of SSAs is associated with bronchial NET (HR 0.078, 95% CI 0.010–0.633; p=0.017), and resistance to treatment is associated with negative expression of SSTR5 (HR 6.532, 95% CI 1.019–41.878; p=0.048). Conclusion. SSAs are the drugs of choice for the first-line treatment of patients with EAS, allowing for long-term effective control of hypercortisolism and tumor progression in more than 60% of patients. Significant factors determining the response to SSAs after 6 months of treatment are expression status of SSTR5 and NET localization.https://ter-arkhiv.ru/0040-3660/article/viewFile/631985/pdfectopic adrenocorticotropic hormone syndromeneuroendocrine tumorhypercortisolismdrug treatmentsomatostatin analogspredictors of response |
| spellingShingle | Olga O. Golounina Zhanna E. Belaya Alla A. Markovich Liudmila Y. Rozhinskaya Galina A. Mel`nichenko Natalia G. Mokrysheva Ivan I. Dedov Efficacy and predictors of response to somatostatin analogues in patients with ectopic ACTH syndrome Терапевтический архив ectopic adrenocorticotropic hormone syndrome neuroendocrine tumor hypercortisolism drug treatment somatostatin analogs predictors of response |
| title | Efficacy and predictors of response to somatostatin analogues in patients with ectopic ACTH syndrome |
| title_full | Efficacy and predictors of response to somatostatin analogues in patients with ectopic ACTH syndrome |
| title_fullStr | Efficacy and predictors of response to somatostatin analogues in patients with ectopic ACTH syndrome |
| title_full_unstemmed | Efficacy and predictors of response to somatostatin analogues in patients with ectopic ACTH syndrome |
| title_short | Efficacy and predictors of response to somatostatin analogues in patients with ectopic ACTH syndrome |
| title_sort | efficacy and predictors of response to somatostatin analogues in patients with ectopic acth syndrome |
| topic | ectopic adrenocorticotropic hormone syndrome neuroendocrine tumor hypercortisolism drug treatment somatostatin analogs predictors of response |
| url | https://ter-arkhiv.ru/0040-3660/article/viewFile/631985/pdf |
| work_keys_str_mv | AT olgaogolounina efficacyandpredictorsofresponsetosomatostatinanaloguesinpatientswithectopicacthsyndrome AT zhannaebelaya efficacyandpredictorsofresponsetosomatostatinanaloguesinpatientswithectopicacthsyndrome AT allaamarkovich efficacyandpredictorsofresponsetosomatostatinanaloguesinpatientswithectopicacthsyndrome AT liudmilayrozhinskaya efficacyandpredictorsofresponsetosomatostatinanaloguesinpatientswithectopicacthsyndrome AT galinaamelnichenko efficacyandpredictorsofresponsetosomatostatinanaloguesinpatientswithectopicacthsyndrome AT nataliagmokrysheva efficacyandpredictorsofresponsetosomatostatinanaloguesinpatientswithectopicacthsyndrome AT ivanidedov efficacyandpredictorsofresponsetosomatostatinanaloguesinpatientswithectopicacthsyndrome |