problendoПроблемы ЭндокринологииProblems of Endocrinology0375-96602308-1430Endocrinology Research Centre10.14341/probl2017635338-345problendo-8811Research ArticleОбзорыReviewsВыявление и преодоление резистентности к аналогам соматостатина в реальной клинической практикеIdentification and overcoming of resistance to somatostatin analogues in real clinical practicehttps://orcid.org/0000-0003-3261-7366ИловайскаяИрэна АдольфовнаIlovayskayaIrena A.

кандидат медицинских наук, доцент, ведущий научный сотрудник отделения терапевтической эндокринологии МОНИКИ им. М.Ф.Владимирского; доцент кафедры поликлинической терапии МГМСУ им. А.И.Евдокимова

MD, PhD, Associate Professor

irena.ilov@yandex.ru<p>Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского; Московский государственный медико-стоматологический университет им. А.И.Евдокимова</p>Россия<p>Vladimirsky Moscow Regional Research Clinical Institute;&nbsp;Evdokimov Moscow State University of Medicine and Dentistry</p>Russian Federation201711122017635338345Copyright &#x00A9; Иловайская И.А., 20172017Иловайская И.А.Ilovayskaya I.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.probl-endojournals.ru/jour/article/view/8811

Под резистентностью к аналогам соматостатина в настоящее время подразумевается отсутствие биохимического и опухолевого ответа на проводимое в течение 12 мес лечение. Адекватным биохимическим ответом считается достижение целевых критериев лечения акромегалии, или хотя бы снижение уровней ГР и/или ИРФ-1 на >50%. Опухолевым ответом на лечения считается уменьшение объема соматотропиномы на ≥20% (при использовании АСС как первой линии лечения). По эффективности лечения пациентов При применении АСС первого поколения большинство (до 60-70 %) пациентов демонстрируют частичную резистентность с той или иной степенью биохимического и/или опухолевого ответа. К клинико-биохимическим предикторам резистентности к АСС относятся молодой возраст, мужской пол, выраженная активность акромегалии, инвазивная соматотропинома больших размеров с гиперинтенсивным Т2-взвешенным МР-сигналом опухоли. В последние годы выявлены также различные молекулярно-генетические предикторы резистентности к АСС, которые необходимо внедрять в широкую клиническую практику для персонифицированного выбора медикаментозного лечения. Из имеющихся в отечественной клинической практике возможностей преодоления резистентности к АСС к медикаментозным методам можно отнести высокодозную терапию АСС и комбинированную терапию максимальными дозами АСС и каберголином; среди немедикаментозных опций – удаление до 75% объема опухоли с последующим возобновлением лечения АСС и облучение.

Resistance to somatostatin analogues (SSAs) is defined as the lack of biochemical and tumor response to the treatment for 12 months. An adequate biochemical response means achieving the target criteria of acromegaly treatment or at least a decrease in the GH and/or IGF-1 levels by >50%. A decrease in the somatotropinoma size by ≥ 20% (when using SSAs as the first line treatment) is considered as the tumor response to treatment. On the basis of treatment efficacy, patients may be classified as non-resistant (biochemical control of acromegaly and tumor response), partially resistant (some degree of biochemical and/or tumor response), and fully resistant (neither biochemical nor tumor response) to SSA therapy. Most patients (up to 60—70%) are partially resistant to the first generation of SSAs. Clinical and biochemical predictors for resistance to SSAs include young age, male gender, high GH/IGF-1 levels, and large invasive sparsely granulated somatotropinoma with high Ki-67 and a hyperintense T2-weighted MRI signal. In recent years, various molecular and genetic predictors for resistance to SSAs have been found; they should be introduced in clinical practice to enable the personalized approach to drug therapy. Treatment options for patients resistant to first-generation SSAs include dose escalation, combined treatment with SSAs and cabergoline, and switching to pasireotide or pegvisomant (not available in Russia); non-drug options include tumor debulking followed by SSA therapy and radiosurgery/radiotherapy.

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The authors declare that there are no conflicts of interest present.