Almanac of Clinical MedicineAlmanac of Clinical MedicineАльманах клинической медицины2072-05052587-9294Moscow Regional Research and Clinical Institute (MONIKI)149610.18786/2072-0505-2022-50-019REVIEW ARTICLEОБЗОРReview ArticleTargeted treatment with somatostatin analogues: widening horizons of clinical practiceТаргетное назначение аналогов соматостатина: расширяющиеся горизонты клинической практикиhttps://orcid.org/0000-0001-5045-798XProninVyacheslav S.ПронинВячеслав Сергеевич
Russian Federation

MD, PhD, Professor, Chair of Endocrinology, Faculty of Therapy

д-р мед. наук, профессор кафедры эндокринологии терапевтического факультета

vspronin@yandex.ruhttps://orcid.org/0000-0002-9944-2997AntsiferovMikhail B.АнциферовМихаил Борисович
Russian Federation

MD, PhD, Professor, Chief Physician

д-р мед. наук, профессор, главный врач

antsiferov@rambler.ruhttps://orcid.org/0000-0003-0066-845XAlexeevaTatiana M.АлексееваТатьяна Марковна
Russian Federation

Physician, Board Certified in Endocrinology

врач-эндокринолог высшей категории

mamamarka@yandex.ruhttps://orcid.org/0000-0001-6094-3623ProninEvgeny V.ПронинЕвгений Вячеславович
Russian Federation

Endocrinologist

врач-эндокринолог

r-wp@mail.ruRussian Medical Academy of Continuous Professional EducationФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииEndocrinological dispensary of Moscow Healthсare DepartmentГБУЗ г. Москвы «Эндокринологический диспансер ДЗМ»08072022261020225031962041106202122062022Copyright ©; 2022, Pronin V.S., Antsiferov M.B., Alexeeva T.M., Pronin E.V.Copyright ©; 2022, Пронин В.С., Анциферов М.Б., Алексеева Т.М., Пронин Е.В.2022Pronin V.S., Antsiferov M.B., Alexeeva T.M., Pronin E.V.Пронин В.С., Анциферов М.Б., Алексеева Т.М., Пронин Е.В.https://creativecommons.org/licenses/by-nc/4.0https://almclinmed.ru/jour/article/view/1496

Targeted treatment with somatostatin analogues (SA) in acromegaly and neuroendocrine neoplasms may have some benefits compared to curative treatments, because these agents decrease excessive hormone secretion and exert a tumor-suppressive effect. Monotherapy and combination therapy with SA is well tolerated and bears no risk of debilitating iatrogenic complications. In acromegaly caused by somatotropin producing pituitary tumor, first generation SA are treatment of choice after non-radical adenomectomy, as well as in the cases when patients reject surgery. Treatment efficacy depends on the pathomorphological types of somatotropic tumors, which are different in their receptor phenotype, clinical scenario and proliferative activity. The first generation SA are successfully used for medical treatment of other pituitary tumors (thyrotropic, corticotropic, gonadotropic, lactotropic with resistance to dopamine agonists), as well as for adjuvant therapy of neuroendocrine and non-endocrine neoplasms and elimination of various gastrointestinal disorders. The anti-secretory and anti-tumor effects of SA have been proven for gastroenteropancreatic tumors (carcinoid syndrome, vipomas, gastrinomas, insulinomas, glucagonomas, somatostatinomas). Targeted selection of patients for treatment with first generation SA based on the receptor phenotypes of malignant cells would facilitate more rapid achievement of biochemical remission, improvement of quality of life and survival.

Таргетное применение аналогов соматостатина (АС) при акромегалии и нейроэндокринных опухолях может иметь некоторые преимущества перед радикальными методами лечения, так как эти препараты снижают избыточную гормональную секрецию и имеют туморсупрессивное действие. В качестве моно- или комбинированной терапии АС характеризуются хорошей переносимостью и отсутствием риска развития инвалидизирующих ятрогенных осложнений. При акромегалии, причиной которой выступает опухоль гипофиза, продуцирующая соматотропин, АС первого поколения относятся к терапии выбора после нерадикальной аденомэктомии, а также при отказе от оперативного лечения. Эффективность лечения зависит от патоморфологических форм соматотрофных опухолей, различающихся по рецепторному фенотипу, клиническому сценарию и пролиферативной активности. АС первого поколения успешно применяются при фармакотерапии других гипофизарных опухолей – тиреотрофных, кортикотрофных, гонадотрофных, лактотрофных (при наличии резистентности к агонистам дофамина), а также для адъювантного лечения нейроэндокринных и неэндокринных неоплазий и коррекции разнообразных нарушений со стороны желудочно-кишечного тракта. Доказано положительное антисекреторное и антинеопластическое действие АС при гастроэнтеропанкреатических опухолях (карциноидном синдроме, випомах, гастриномах, инсулиномах, глюкагономах, соматостатиномах). Целевой отбор пациентов на лечение АС первого поколения с учетом рецепторного фенотипа опухолевых клеток будет способствовать скорейшему достижению биохимической ремиссии, повышению качества и продолжительности жизни пациентов.

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