IGF1 and neoplasm: I consider combination therapy where resources are available of first-generation SSAs with pegvisomant in patients with small residual tumor after surgery, with persistently above normal IGF-1(≥1.5–2 ULN) while on the maximum tolerated dose of SSA (usually 40 mg octreotide or 120 mg lanerotide monthly) for at least 6 months.