Safety of growth hormone replacement in survivors of cancer and intracranial and pituitary tumours: a consensus statement

Margaret C.S. Boguszewski, Cesar L. Boguszewski, Wassim Chemaililly, Laurie E. Cohen, Judith Gebauer, Claire Higham, Andrew R. Hoffman, Michel Polak, Kevin C.J. Yuen, Nathalie Alos, Zoltan Antal, Martin Bidlingmaier, Beverley M.K. Biller, George Brabant, Catherine S.Y. Choong, Stefano Cianfarani, Peter E. Clayton, Regis Coutant, Adriane A. Cardoso-Demartini, Alberto FernandezAdda Grimberg, Kolbeinn Guðmundsson, Jaime Guevara-Aguirre, Ken K Y Ho, Reiko Horikawa, Andrea M. Isidori, Jens Otto Lunde Jørgensen, Peter Kamenicky, Niki Karavitaki*, John J. Kopchick, Maya Lodish, Xiaoping Luo, Ann I. McCormack, Lillian Meacham, Shlomo Melmed, Sogol Mostoufi Moab, Hermann L. Müller, Sebastian J.C.M.M. Neggers, Manoel H. Aguiar Oliveira, Keiichi Ozono, Patricia A. Pennisi, Vera Popovic, Sally Radovick, Lars Savendahl, Philippe Touraine, Hanneke M. van Santen, Gudmundur Johannsson

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Growth hormone (GH) has been used for over 35 years, and its safety and efficacy has been studied extensively. Experimental studies showing the permissive role of GH/insulin-like growth factor 1 (IGF-I) in carcinogenesis have raised concerns regarding the safety of GH replacement in children and adults who have received treatment for cancer and those with intracranial and pituitary tumours. A consensus statement was produced to guide decision-making on GH replacement in children and adult survivors of cancer, in those treated for intracranial and pituitary tumours and in patients with increased cancer risk. With the support of the European Society of Endocrinology, the Growth Hormone Research Society convened a Workshop, where 55 international key opinion leaders representing 10 professional societies were invited to participate. This consensus statement utilized: (1) a critical review paper produced before the Workshop, (2) five plenary talks, (3) evidence-based comments from four breakout groups, and (4) discussions during report-back sessions. Current evidence reviewed from the proceedings from the Workshop does not support an association between GH replacement and primary tumour or cancer recurrence. The effect of GH replacement on secondary neoplasia risk is minor compared to host- and tumour treatment-related factors. There is no evidence for an association between GH replacement and increased mortality from cancer amongst GH-deficient childhood cancer survivors. Patients with pituitary tumour or craniopharyngioma remnants receiving GH replacement do not need to be treated or monitored differently than those not receiving GH. GH replacement might be considered in GH-deficient adult cancer survivors in remission after careful individual risk/benefit analysis. In children with cancer predisposition syndromes, GH treatment is generally contraindicated but may be considered cautiously in select patients.

Original languageEnglish
Pages (from-to)35-52
Number of pages18
JournalEuropean Journal of Endocrinology
Volume186
Issue number6
Early online date21 Apr 2021
DOIs
Publication statusPublished - Jun 2022

Bibliographical note

Funding Information:
The consensus workshop was funded by the Growth Hormone Research Society with a non-financial support from the European Society of Endocrinology.

Funding Information:
M C S B: lecture fees and/or consultancy honoraria from Merck, Pfizer, Sandoz, Novo Nordisk. L E C: lecture and/or consultancy honoraria from Novo Nordisk and Sandoz, Pfizer site P 阀 on long-acting growth hormone study and sub-P 阀 on investigator-initiated research grant to Boston Children’s Hospital. A R H: consultant for Novo Nordisk and Ascendis. M P: Research support from Pfizer, Novo Nordisk, 阀PSEN, Sandoz, Merck-Serono, Lilly, Sanofi, National French Grants, public funding, ANR and PHRC, and Scientific advisory board: 阀ncrelex ( 阀PSEN), GNAP (Novo Nordisk), K 阀GS France (Pfizer). K C J Y: Research grants to Barrow Neurological 阀nstitute from Ascendis, Crinetics, Amryt, and Corcept, and Scientific Advisory Boards for Novo Nordisk, Ascendis, Amryt, 阀psen, Strongbridge, Recordati, and Corcept. M B: Research support, lecture fees, and/or consultancy honoraria from Diasorin, Genexine, Genescience, 阀DS, 阀PSEN, Merck, Novartis, OPKO, Pfizer, Roche, Sandoz. B M K B: P 阀 of research grants to Massachusetts General Hospital from Ascendis, Crinetics and 阀onis and occasional consultant for Novo Nordisk, HRA Pharma, Merck Serono, 阀psen, and Recordati. C S Y C: 阀nvestigator on OPKO-sponsored Long-Acting Growth Hormone study. S C: Consultant for Novo Nordisk and Sandoz. P E C: Research grant from Novo Nordisk Chair, Data Monitoring Committee for the 阀psen 阀ncrelex Registry; Member of the Scientific Advisory Board for Lumos Pharma. R C: Scientific advisory board Pfizer, Novo Nordisk and Merck-Serono. A F: Scientific advisory board: Pfizer, Novo Nordisk, Merck-Serono, Research support: Novo Nordisk, Sandoz. A G: The 2020 Growth Hormone Research Competitive Grant Program Award from Pfizer. K K Y H: Advisory Board, Novo Nordisk. R H: Advisory board, research grant and lecturer: Novo Nordisk, Pfizer, Opko, Ascendis, Sandoz. A M 阀: Consultancies for Recordati, Serono Fundation, Novo Nordisk Foundation, 阀psen and grants from Takeda and Pfizer. J O L J: Consulting fee from Novo Nordisk and unrestricted research grants from Pfizer. P K: 阀nvitations to congresses and lecturing fees from Pfizer and 阀psen. N K: Research and educational grants, advisory board and lecturing fees from Pfizer. S M: Research grant to 阀nstitution from Pfizer and Consultant for Novo Nordisk. H M: has received reimbursement of participation fees for scientific meetings and continuing medical education events from Ferring, Lilly, Pfizer, Sandoz/ Hexal, Novo Nordisk, 阀psen, and Merck Serono. Reimbursement of travel expenses from 阀psen and lecture honoraria from Pfizer. Supported by the German Childhood Cancer Foundation, Bonn, Germany. L S: Personal fees and non-financial support from Ascendis, Hexal, Merck, Novo Nordisk, Pfizer, and Sandoz. P T: Lectures fees from Novo Nordisk, 阀psen, Pfizer, Merck. G J: Consulting fee from Novo Nordisk and unrestricted research grants from NovoNordisk and Pfizer.

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