Biomarkers of response to treatment in acromegaly

ABSTRACT

Introduction

Medical treatment of acromegaly is based in a `trial and error` approach. First-generation somatostatin receptor ligands (fg-SRL) are prescribed as first-line medical therapy to the vast majority of patients, despite lack of disease control in approximately 60% of patients. However, other drugs used in acromegaly treatment are available (cabergoline, pasireotide and pegvisomant).

Areas covered

In this article, we review and discuss the biomarkers of response to medical treatment in acromegaly.

Expert opinion

Biomarkers for fg-SRL that can already be applied in clinical practice are: gender, age, pretreatment GH and IGF-I levels, cytokeratin granulation pattern, and the expression of somatostatin receptor type 2. Using biomarkers of response could guide treatment towards precision medicine with greater efficacy and lower costs.

KEYWORDS:

• Acromegaly
• biomarkers
• medical treatment
• precision medicine
• somatostatin receptor ligand

Article highlights

• Current treatment of acromegaly is based on a ‘trial and error’ approach;

• Biomarkers of response to different drugs may help change the current approach to a more individualized approach (precision medicine);

• There are more evidence in the literature of biomarkers of response to first-generation somatostatin receptor ligands (fg-SRLs);

• Biomarkers of response to fg-SRLs with more robust evidence are age, gender, pre-treatment GH and IGF-I levels, SST2, and SST5 expression, cytokeratin pattern, Ki-67 and the presence of an AIP mutation;

• For other drugs (cabergoline, pasireotide, and pegvisomant) there are also some biomarkers described, but with less robust evidence;

• Future advancements in this field may help change the disease treatment towards precision medicine with greater efficacy and lower costs.

Additional information

Funding

This paper was not funded.