Endocrine Abstracts

JOINT2531

Introduction: Aggressive PitNets, defined as rapidly growing and resistant to the standard treatment tumors, often present with severe headaches and require individualized multimodal treatment. Pasireotide exhibits antitumor properties and a unique analgesic effect in PitNets.

Objectives: To correlate headaches and SIBs in aggressive PitNets treated with pasireotide.

Methods: We analyzed data regarding the severity of the headaches (according to NRS scale) from 19 patients — 11 men and 8 women with different PitNets: 10 somatotropinomas (38.5%), four corticotropinomas (23.1%), two silent corticotropinomas (7.6%), two gonadotropinomas (7.6%), and one prolactinoma (3.8%) treated with pasireotide in correlation with SIBs.

Results: The average age on diagnosis was 45 years (min -13; max – 86). The maximum tumor diameter was 89 mm. 18/19 (95%) patients were treated pharmacologically before pasireotide implementation. All patients with acromegaly were previously treated with first-generation somatostatin analogs (SA). The patients treated surgically 14/19 were significantly younger than others (40 vs. 66 years), p = 0.014. 15/19 patients complained of headaches. The mean value on the NRS scale at baseline was 6,5 (max-10; min-2), while after the pasireotide was 0,7 (max-4; min-0). 100% of patients reported alleviation or disappearance of headaches (OR – 1.34; 95%CI (0.702-1.950), p<0.001). Furthermore, a correlation between baseline NRS and WBC was found (rho=0.478, p=0.05) Patients with acromegaly (acro) achieved higher PLT/lYMPH ratio values than others (nonacro) (187,2 vs 119,5), P = 0.006. Moreover, we observed a strong correlation between higher PLT/lYMPH ratio and higher GH and IGF-1 values (rho=0.736, P = 0.01 and rho=0.709, P = 0.05). Furthermore, we observed a strong correlation between baseline NRS and NEU/PLT ratio in nonacro group (rho=0.859, P = 0.01). In 15/19(79%) patients, the tumor dimensions stabilized or shrank; in 4 patients, the follow-up MRI has not yet been performed. 79% obtained biochemical control of the disease.

Conclusion: Pasireotide is a second-generation SA used in acromegaly and Cushing’s disease. Nevertheless, it effectively achieves biochemical control in other PitNET subtypes and relieves headaches.

Keywords: Pasireotide, Aggressive PitNets, Acromegaly, Cushing syndrome, systemic inflammation biomarkers.