Clinical Benefits of Above-Standard Dose of Octreotide LAR in Patients With Neuroendocrine Tumors for Control of Carcinoid Syndrome Symptoms: A Multicenter Retrospective Chart Review Study

Strosberg, Jonathan R.; Benson, Al B.; Huynh, Lynn; Duh, Mei Sheng; Goldman, Jamie; Sahai, Vaibhav; Rademaker, Alfred; Kulke, Matthew H.

doi:10.1634/theoncologist.2014-0120

Cited by 96 publications

(77 citation statements)

References 16 publications

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“…This is in contrast to retrospective studies that have shown that patients with refractory carcinoid syndrome achieve symptom control by increasing dose ofoctreotide LAR beyond 30 mg [14,17]. These data are in line with consensus guidelines recommending titration of octreotide LAR dose beyond 20-30 mg as required for symptom control.…”

Section: Discussionsupporting

confidence: 77%

“…While the PROMID trial evaluated octreotide LAR 30 mg in comparison with placebo, the National Comprehensive Cancer Network guidelines recommend either 20 mg or 30 mg of octreotide LAR as reasonable choices for initial dose [2,6]. Other retrospective studies have shown that there is even larger variability in current clinical practice, with doses as low as 10 mg being used [14]. This is particularly important because our study showed significant differences in survival according to octreotide LAR dosage levels.…”

Section: Discussionmentioning

confidence: 71%

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Octreotide LAR Dosage and Survival Among Elderly Patients With Distant-Stage Neuroendocrine Tumors

Shen

Dasari

et al. 2016

The Oncologist

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Introduction. Octreotide long-acting repeatable (LAR) is approved for the management of carcinoid syndromes and may improve progression-free survival of patients with well-differentiated neuroendocrine tumors (NETs). It is unknown whether the dosage of octreotide LAR affects survival. This paper evaluates the association between initial octreotide LAR dosage and overall survival of elderly patients with NETs. Patients and Methods. Patients with distant-stage NET diagnosed between January 1999 and December 2009 who received octreotide LAR treatment within 12 months of diagnosis were identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Those under age 65 years, enrolled in health maintenance organizations, or without continuous enrollment in Medicare Parts A and B were excluded. We compared the 5-year survival of patients with NET based on dose per 28 days averaged over the initial

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 71%

Octreotide LAR Dosage and Survival Among Elderly Patients With Distant-Stage Neuroendocrine Tumors

Shen

Dasari

et al. 2016

The Oncologist

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“…However, potential side effects may occasionally develop and need to be considered, as many patients are treated with these compounds for a prolonged period (Table 3). When symptom control is inadequate, top-up doses of 50-100 μg (up to 1000 μg) of short-acting octreotide s.c. can be given or alternatively the frequency or dose of long-acting SSA administration can be increased (Rubin et al 1999, Strosberg et al 2014. In an initial prospective study, 28 patients with CS with disease progression during therapy with octreotide LAR 30 mg every 28 days exhibited complete and partial control of symptoms after octreotide LAR 30 mg administration every 21 days in 40 and 60% of the cases, respectively; circulating biomarkers were significantly decreased in 30% (Ferolla et al 2012).…”

Section: :9mentioning

confidence: 99%

Medical management of secretory syndromes related to gastroenteropancreatic neuroendocrine tumours

Dimitriadis¹,

Weickert²,

Randeva³

et al. 2016

Endocrine-Related Cancer

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Although recent epidemiological evidence indicates that the prevalence of non-functioning gastroenteropancreatic (GEP) neuroendocrine tumours (NETs) is rising, a significant number of GEP-NETs still present with symptoms related to the secretion of biologically active substances leading to the development of distinct clinical syndromes. In the past, these syndromes were associated with substantial morbidity and mortality due to the lack of specific therapies; however, since the introduction of long-acting somatostatin analogues and medications such as proton pump inhibitors, their control has been greatly improved. As a result, nowadays, the main cause of morbidity and mortality in GEP-NETs is mostly directly related to tumour growth and the extent of metastatic disease. However, in some patients with functioning tumours and extensive disease, control of the secretory syndrome still remains problematic, necessitating the employment of several cytoreductive techniques, which may not always be sufficient. Recently, new agents directed against tumour growth, or exerting increased binding activity to receptors expressed in these tumours, or interfering with the synthetic pathway of some of the compounds secreted by these tumours, have been developed. Since there are no specific guidelines addressing the totality of the management of the secretory syndromes related to GEP-NETs, this review aims at critically analysing the medical management of previously recognised secretory syndromes; it also addresses areas of uncertainty, assesses the newer therapeutic developments and also addresses recently described but poorly characterised secretory syndromes related to GEP-NETs.

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“…Studies on long-acting analogues demonstrate a symptomatic response rate of 70% (50) in patients with the carcinoid syndrome, and referring specifically to flushing, a response rate of 50-60% (51,52). Since the goal of improving symptom control is a common reason for somatostatin analogue dose escalation, Strosberg et al have recently evaluated the effects of above-standard dose of octreotide LAR in a multicentre study, concluding that the resolution or improvement of flushing after dose escalation can be observed in 80% of patients (53). When no symptomatic control is achieved, another option of treatment would be the novel multireceptor-targeted somatostatin analogue pasireotide (previously known as SOM230).…”

Section: Carcinoid Syndromementioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Flushing: current concepts

Huguet

Grossman

2017

European Journal of Endocrinology

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Objective: Flushing can be defined as a sensation of warmth accompanied by erythema that most commonly is seen on the face and which occurs in episodic attacks. Such a problem can be clinically problematic, since many conditions and drugs can be related to flushing, and while often there appears to be no underlying organic disease, it is important to exclude disorders since they may be life-threatening conditions. Design and methods: We performed a search in MEDLINE using the terms 'flushing' in combination with 'carcinoid syndrome', 'pheochromocytoma', 'mastocytosis', 'menopausal hot flush' and 'treatment'. European and American guidelines relating to neuroendocrine tumours, mastocytosis and menopause were reviewed. Results: In this review, we discuss the main causes of flushing and propose an algorithm based on pathogenesis, which can be used to guide the clinical evaluation process. We also review recent significant developments in the assessment and treatment of the carcinoid syndrome and menopausal hot flushes, which should guide the clinical practice regarding this common but sometimes confusing condition. Conclusions: When evaluating flushing, a precise systematic approach is needed to exclude potentially serious underlying causes, although despite this, the cause of the disorder is not always found. If symptoms are not progressive, the patient should be advised about its apparently benign nature in order to avoid unnecessary studies or initiating treatments of minimal benefit.

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Clinical Benefits of Above-Standard Dose of Octreotide LAR in Patients With Neuroendocrine Tumors for Control of Carcinoid Syndrome Symptoms: A Multicenter Retrospective Chart Review Study

Cited by 96 publications

References 16 publications

Octreotide LAR Dosage and Survival Among Elderly Patients With Distant-Stage Neuroendocrine Tumors

Octreotide LAR Dosage and Survival Among Elderly Patients With Distant-Stage Neuroendocrine Tumors

Medical management of secretory syndromes related to gastroenteropancreatic neuroendocrine tumours

MANAGEMENT OF ENDOCRINE DISEASE: Flushing: current concepts

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