The role of lanreotide Autogel^® in the treatment of acromegaly

Abstract

Acromegaly is a rare disease, but all clinicians have to be aware of the diagnosis in order to minimize the negative consequences of increased levels of growth hormone and IGF-I, and the possible impact of a pituitary macroadenoma. Surgery remains the first-line therapy and may alleviate both hormonal excess and symptoms due to tumor mass effects. Postoperatively, however, many patients may need adjunctive therapy. Somatostatin analogs were marketed for clinical use in the 1980s. The depot formulations of the synthetic somatostatin analogs octreotide and lanreotide, octreotide acetate long-acting repeatable and lanreotide sustained release, were developed by incorporating the analogs into microspheres. The advantage of the new formulation of lanreotide, lanreotide Autogel^®, is the prefilled syringe of lanreotide and water. The choice of analog should be individualized for each patient based on level of efficacy, adverse event profile and preferred mode of administration. Approximately a third of acromegalic patients are resistant to the currently available somatostatin analogs. Monotherapy using cabergoline or pegvisomant is clinically available. Adding cabergoline to a somatostatin analog may be advantageous in selected patients and promising data exist regarding combination therapy with pegvisomant. Radiotherapy is still an option; however, although treating comorbidities and avoiding hypopituitarism is very important, radiotherapy should only be used for selected patients where treatment targets cannot be achieved by using the other therapies.

Keywords::

• adenoma
• growth hormone
• lanreotide Autogel^®
• pituitary
• somatostatin

Disclosure

The author has received research funding and lecture honoraria from Novartis and Ipsen.