This protocol applies to patients with acromegaly whose tumor cannot be cured surgically — because of extensive cavernous sinus invasion (without optic chiasm compression) or poor surgical candidacy — and who have not achieved adequate biochemical control on primary SRL therapy.
Tumor not curable by surgery; extensive cavernous sinus invasion without optic chiasm compression; poor surgical candidate. For this population, a somatostatin receptor ligand (SRL) is the appropriate first-line medical approach.
The prior line — primary medical therapy with a somatostatin receptor ligand (SRL) — did not achieve its required targets: an age-normalized serum IGF-1 and a random GH < 1.0 µg/L, assessed after 12 weeks. Failure to meet these biochemical goals is the trigger for escalation to this next-line protocol.
In this situation, combination medical therapy is considered — the existing SRL is continued and a second agent is added. The complete structured regimen, including which agents are appropriate and how they are individualized, is available in the full protocol.
Normalization of serum IGF-1.
Age-normalized serum IGF-1
DOI: 10.1210/jc.2014-2700
We suggest use of an SRL as primary therapy in a patient who cannot be cured by surgery, has extensive cavernous sinus invasion, does not have chiasmal compression, or is a poor surgical candidate.
We suggest addition of pegvisomant or cabergoline in a patient with inadequate response to an SRL.
We suggest a biochemical target goal of an age-normalized serum IGF-1 value, which signifies control of acromegaly.
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