Endocrinol Metab.  2014 Sep;29(3):280-292. 10.3803/EnM.2014.29.3.280.

Early Prediction of Long-Term Response to Cabergoline in Patients with Macroprolactinomas

• Lee Y
• Ku CR
• Kim EH
• Hong JW
• Lee EJ
• Kim SH

• KMID: 2169464
• DOI: http://doi.org/10.3803/EnM.2014.29.3.280

Abstract

BACKGROUND
Cabergoline is typically effective for treating prolactinomas; however, some patients display cabergoline resistance, and the early characteristics of these patients remain unclear. We analyzed early indicators predicting long-term response to cabergoline.
METHODS
We retrospectively reviewed the cases of 44 patients with macroprolactinomas who received cabergoline as first-line treatment; the patients were followed for a median of 16 months. The influence of various clinical parameters on outcomes was evaluated.
RESULTS
Forty patients (90.9%) were treated medically and displayed tumor volume reduction (TVR) of 74.7%, a prolactin normalization (NP) rate of 81.8%, and a complete response (CR; TVR >50% with NP, without surgery) rate of 70.5%. Most patients (93.1%) with TVR > or =25% and NP at 3 months eventually achieved CR, whereas only 50% of patients with TVR > or =25% without NP and no patients with TVR <25% achieved CR. TVR at 3 months was strongly correlated with final TVR (R=0.785). Patients with large macroadenomas exhibited a low NP rate at 3 months, but eventually achieved TVR and NP rates similar to those of patients with smaller tumors. Surgery independently reduced the final dose of cabergoline (beta=-1.181 mg/week), and two of four patients who underwent surgery were able to discontinue cabergoline.
CONCLUSION
Determining cabergoline response using TVR and NP 3 months after treatment is useful for predicting later outcomes. However, further cabergoline administration should be considered for patients with TVR >25% at 3 months without NP, particularly those with huge prolactinomas, because a delayed response may be achieved. As surgery can reduce the cabergoline dose necessary for successful disease control, it should be considered for cabergoline-resistant patients.

Keyword

Cabergoline; Dopamine; Prolactinoma; Hyperprolactinemia

MeSH Terms

Dopamine
Humans
Hyperprolactinemia
Prolactin
Prolactinoma*
Retrospective Studies
Tumor Burden
Dopamine
Prolactin

Figure

• 

  Fig. 1 Changes in prolactin (PRL) levels and tumor volume reduction (TVR) in two groups according to baseline tumor volume. Black lines indicate patients with larger tumors (larger group); gray lines, patients with smaller tumors (smaller group). The cutoff between the two groups was a baseline tumor volume of 18 cm3. Each P value between the groups was calculated at each time point with the Mann-Whitney U test. At each time point, the patients who underwent surgery before the assessment were excluded. (A) Changes in median PRL levels. (B) Changes in median TVR.

• 

  Fig. 2 Fate of 44 patients with macroprolactinomas according to early response. (A) Overall progress of patients according to categorization by early response. (B) Prolactin (PRL) levels of the patients in group 2. Black line indicates patients who eventually achieved normalization of prolactin level (NP; delayed response subgroup); gray line, patients who did not achieve NP (sustained resistance subgroup). TVR, tumor volume reduction. aP<0.05 between the subgroups, the P value was calculated with the Mann-Whitney U test.

• 

  Fig. 3 Correlation between late tumor volume reduction (TVR) and early TVR. The Pearson correlation analysis was used for statistical analysis.

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