Identification and overcoming of resistance to somatostatin analogues in real clinical practice
https://doi.org/10.14341/probl2017635338-345
Abstract
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.
About the Author
Irena A. IlovayskayaVladimirsky Moscow Regional Research Clinical Institute; Evdokimov Moscow State University of Medicine and Dentistry
Russian Federation
MD, PhD, Associate Professor
Competing Interests:
Нет конфликта интересов, связанных с данной публикацией
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Ilovayskaya I.A. Identification and overcoming of resistance to somatostatin analogues in real clinical practice. Problems of Endocrinology. 2017;63(5):338-345. https://doi.org/10.14341/probl2017635338-345
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