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Treatment of multiresistant prolactinomas with a combination of cabergoline and octreotide LAR

Ernesto Sosa-Eroza1, Etual Espinosa1, Claudia Ramírez-Rentería1

  • 1Endocrinology Service and the Experimental Endocrinology Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, MX, USA.

Endocrine
|June 28, 2018
PubMed
Abstract

Insights

Dopamine agonist-resistant prolactinomas are challenging. Adding octreotide LAR to cabergoline showed significant prolactin reduction and tumor shrinkage in some patients, offering a new treatment option.

Area of Science:

  • Endocrinology
  • Oncology
  • Pharmacology

Background:

  • Dopamine agonist (DA)-resistant prolactinomas present a significant therapeutic challenge due to limited treatment alternatives.
  • Macroprolactinomas, particularly those resistant to DA therapy, require novel management strategies.

Purpose of the Study:

  • To evaluate the efficacy of adding octreotide long-acting repeatable (LAR) to cabergoline (CBG) treatment in patients with DA-resistant macroprolactinomas.
  • To assess the impact on prolactin (PRL) levels and tumor size.

Main Methods:

  • A proof-of-concept study involving five patients with macroprolactinomas resistant to high-dose cabergoline and prior surgery.
  • Patients received 20 mg monthly octreotide LAR in addition to ongoing cabergoline for 6-13 months.
  • Response was assessed via prolactin levels, MRI, and immunohistochemistry (IHC) for somatostatin receptor subtypes (SSTR2 and SSTR5) in two cases.

Main Results:

  • Three out of five patients showed no significant change in PRL levels or tumor size with the combination therapy.
  • Two patients experienced substantial reductions in both PRL concentrations (e.g., from 7643 to 200 ng/mL) and adenoma size (up to 93% reduction).
  • IHC analysis in responders and non-responders revealed positive SSTR5 staining, irrespective of SSTR2 expression.

Conclusions:

  • The addition of a somatostatin analog may be a viable therapeutic option for select patients with dopamine agonist-resistant macroprolactinomas.
  • Treatment efficacy appears independent of the adenoma's somatostatin receptor expression profile (SSTR2/SSTR5).
Keywords:
Macroprolactinomacabergolinedopamine agonistoctreotidesomatostatin receptors

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