PŘEHLEDOVÉ ČLÁNKY Pegvisomant v liečbe akromegálie | E21 / Vnitř Lék. 2022;68(7):E16-E22 / VNITŘNÍ LÉKAŘSTVÍ www.casopisvnitrnilekarstvi.cz s miernou akromegáliou (47). Existujú tri okolnosti za ktorých by mohla byť liečba PEG zvážená ako prvolíniová pooperačne: 1. pacienti, ktorí podstúpili predoperačne dostatočne dlhú liečbu SSA (> 3 – 6 mesiacov), ktorá nebola dostatočne účinná pri kontrole RH a IGF-1 a nemajú veľký reziduálny tumor s útlakom okolitých štruktúr (pri debulkingu viac ako 75 % tumoru) (47, 48) 2. pacienti s reziduálnym nádorom, u ktorých sa plánuje podať rádioterapia ako ďalšia terapia (po ožiarení môžu pretrvávať zvýšené hladiny IGF-1 dlhší čas do nástupu účinku liečby, ale pravdepodobnosť opätovného rastu nádoru je malá) (48) 3. pacienti s nedostatočne kontrolovanýmDM, u ktorých liečba SSA môže potenciálne zhoršiť metabolizmus glukózy (26, 27, 28) Farmakologická liečba druhej línie Pacienti bez odpovede na liečbu SSA po dostatočne dlhom (6 až 12-mesačnom) období liečby maximálnymi dávkami SSA by mali prejsť na monoterapiu PEG (48). Ak sa nedosiahne biochemická kontrola akromegálie, dávka PEG sa má zvýšiť a/alebo sa má podať kombinovaná liečba s DA (obrázok 1). U pacientov, ktorí nedosahujú biochemickú kontrolu ochorenia (48), ale majú zdokumentovanú čiastočnú odpoveď na SSA (50 % zníženie RH a IGF-1 oproti východiskovej hodnote a/alebo zmenšenie nádoru o 20 %), môžu prejsť na monoterapiu PEG alebo kombinovanú liečbu PEG + SSA. Ak kombinácia PEG a SSA nie je účinná, možnou alternatívou môže byť kombinovaná liečba PEG a DA (Obr. 1). Záver V posledných rokoch sa menili indikácie, dávkovanie, pokyny na sledovanie pacientov s akromegáliou a boli vyvinuté nové stratégie kombinovaných terapií na zlepšenie ich kompenzácie. PEG je efektívna a bezpečná možnosť liečby pre mnohých pacientov s akromegáliou, ktorí nedosiahnu adekvátnu kontrolu pri liečbe SSA. LITERATÚRA 1. John A Jane Jr., Edward R Laws. Surgical Treatment of Pituitary Adenomas. Dostupné z https://www.ncbi.nlm.nih.gov/books/NBK278983/. 2. 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