Efficacy and Safety of Pasireotide in Insulinoma-Associated Hypoglycemia.

Context: Persistent hypoglycemia is a life-threatening complication in insulinoma patients. When tumor excision is not possible, medical treatments are the main option. Pasireotide has shown promise in managing refractory hypoglycemia, but its use has been reported only in case series and reports.

Objective: This work aimed to assess the efficacy and safety of pasireotide in treating insulinoma-associated hypoglycemia.

Methods: We conducted a systematic review on using pasireotide to treat insulinoma-associated hypoglycemia, following a predeveloped protocol. We searched MEDLINE, Scopus, Google Scholar, and references forward and backward from database inception to March 30, 2024.

Results: Of 490 identified studies, 137 were reviewed, and 17 cases from 13 studies met the inclusion criteria. Patients' ages ranged from 52 to 71 years (9 women). Five patients (30%) underwent surgical tumor resection. Pasireotide was never the initial treatment. The most common doses were 40 to 60 mg/month for pasireotide long-acting release and 0.6 mg/12 h for short-acting pasireotide. Six patients (35%) showed no improvement, 4 (23%) had partial improvement, and 7 (41%) had complete resolution. Patients with aggressive insulinomas had a lower response rate, with 55% showing no improvement compared to 16% in indolent cases. Larger tumors were significantly associated with poorer response (P = .043). Hyperglycemia was the most common side effect (n = 3).

Conclusion: Pasireotide effectively restored glucose levels in insulinoma patients who failed prior treatments. However, its efficacy was lower in aggressive insulinomas, emphasizing the need for alternative or combinatory strategies in metastatic cases. Given that pasireotide was never used as a first-line therapy in the reviewed cases, earlier administration in selected patients may improve outcomes.