Beck-Peccoz Paolo, Höybye Charlotte, Murray Robert D, Simsek Suat, Zabransky Markus, Zouater Hichem, Stalla Günter
Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda Ospedale Maggiore Policlinico, Milano, Italy.
Department of Endocrinology, Karolinska University Hospital and Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
Ther Adv Endocrinol Metab. 2020 Sep 10;11:2042018820943377. doi: 10.1177/2042018820943377. eCollection 2020.
To assess the safety (particularly the occurrence of malignancies) of growth hormone (GH) replacement (Omnitrope) in adults with GH deficiency, using data from the ongoing PATRO Adults post-marketing surveillance study.
PATRO Adults is being conducted in hospitals and specialized endocrinology clinics across Europe. All enrolled patients who receive ⩾1 dose of Omnitrope are included in the safety population. Malignancies are listed as adverse events under the MedDRA System Organ Class 'neoplasms, benign, malignant and unspecified (including cysts and polyps)'.
As of July 2018, 1293 patients had been enrolled in the study and 983 (76.0%) remained active in the study. Approximately half [ = 637 (49.3%)] of the patients were GH treatment-naïve on study entry. The majority of enrolled patients had multiple pituitary hormone deficiency ( = 1128, 87.2%). A total of 41 on-study malignancies were reported in 33 patients (2.6%; incidence rate 7.94 per 1000 patient-years). The most common cancers were basal cell carcinoma ( = 13), prostate ( = 6), breast, kidney and malignant melanoma (each = 3). Treatment with Omnitrope was discontinued following diagnosis of malignancy in 16 patients. The tumors occurred after a mean of 79.4 months of recombinant hormone GH (rhGH) treatment overall.
Based on this snapshot of data from PATRO Adults, Omnitrope treatment is tolerated in adult patients with GH deficiency in a real-life clinical practice setting. Our results do not generally support a carcinogenic effect of rhGH in adults with GH deficiency, although an increased risk of second new malignancies in patients with previous cancer cannot be excluded based on the current dataset.
利用正在进行的PATRO成人上市后监测研究的数据,评估生长激素(GH)替代治疗(奥曲肽)在成人生长激素缺乏患者中的安全性(尤其是恶性肿瘤的发生情况)。
PATRO成人研究在欧洲各地的医院和专业内分泌诊所开展。所有接受≥1剂奥曲肽的入组患者均纳入安全性人群。在MedDRA系统器官分类“肿瘤,良性、恶性及未特定的(包括囊肿和息肉)”下,恶性肿瘤被列为不良事件。
截至2018年7月,1293例患者入组该研究,983例(76.0%)仍在研究中。大约一半[=637例(49.3%)]患者在研究开始时未接受过GH治疗。大多数入组患者存在多种垂体激素缺乏(=1128例,87.2%)。33例患者共报告了41例研究期间发生的恶性肿瘤(2.6%;发病率为每1000患者年7.94例)。最常见的癌症是基底细胞癌(=13例)、前列腺癌(=6例)、乳腺癌、肾癌和恶性黑色素瘤(各=3例)。16例患者在诊断为恶性肿瘤后停用了奥曲肽治疗。总体而言,这些肿瘤在重组激素GH(rhGH)治疗平均79.4个月后出现。
基于PATRO成人研究的这一数据快照,在现实临床实践环境中,成人生长激素缺乏患者对奥曲肽治疗耐受性良好。我们的结果总体上不支持rhGH对成人生长激素缺乏患者有致癌作用,尽管根据当前数据集不能排除既往患癌患者发生第二种新发恶性肿瘤的风险增加。