Personalized medicine in acromegaly: The ACROFAST study.

Fecha de publicación: 29/06/2024 Fecha Ahead of Print: 01/08/2024

Autores de IIS La Fe

Rosa Cámara Gómez

Autor

Participantes ajenos a IIS La Fe

Marques-Pamies, Montserrat
Gil, Joan
Sampedro-Nunez, Miguel
Valassi, Elena
Biagetti, Betina
Gimenez-Palop, Olga
Hernandez, Marta
Martinez, Silvia
Carrato, Cristina
Villar-Taibo, Rocio
Araujo-Castro, Marta
Blanco, Concepcion
Simon-Muela, Inmaculada
Simo-Servat, Andreu
Xifra, Gemma
Vazquez, Federico
Pavon, Isabel
Rosado, Jose Antonio
Garcia-Centeno, Rogelio
Zavala, Roxana
Hanzu, Felicia Alexandra
Mora, Mireia
Aulinas, Anna
Vilarrasa, Nuria
Librizzi, Soledad
Calatayud, Maria
de Miguel, Paz
Alvarez-Escola, Cristina
Pico, Antonio
Salinas, Isabel
Fajardo-Montanana, Carmen
Bernabeu, Ignacio
Jorda, Mireia
Webb, Susan M
Marazuela, Monica
Puig-Domingo, Manel

Grupos

Unidad Mixta de Investigación en Endocrinología, Nutrición y Dietética clínica

Leader

Juan Francisco Merino Torres

Abstract

Medical treatment of acromegaly is currently performed through a trial-error approach using first generation somatostatin receptor ligands (fgSRLs) as first-line drugs, with an effectiveness of about 50%, and subsequent drugs are indicated through clinical judgment. Some biomarkers can predict fgSRLs response. Here we report the results of the ACROFAST study, a clinical trial in which a protocol based on predictive biomarkers of fgSRLs was evaluated. METHODS AND SUBJECTS: prospective trial (21 university hospitals) comparing the effectiveness and time-to control of two treatment protocols during 12 months: A) A personalized protocol in which first option were fgSRLs as monotherapy or in combination with pegvisomant or, pegvisomant as monotherapy depending on the short Acute Octreotide Test (sAOT) results, tumor T2 Magnetic Resonance (MRI) signal or immunostaining for E-cadherin and, B) A control group with treatment always started by fgSRLs and the other drugs included after demonstrating inadequate control. RESULTS: Eighty-five patients participated; 45 in the personalized and 40 in the control group. More patients in the personalized protocol achieved hormonal control compared to those in the control group (78% vs 53%, p<0.05). Survival analysis revealed a hazard ratio for achieving hormonal control adjusted by age and sex of 2.53 (CI 1.30-4.80). Patients from personalized arm were controlled in a shorter period of time (p=0.01). CONCLUSION: Personalized medicine is feasible using a relatively simple protocol and allows a higher number of patients achieving control in a shorter period of time.