Gastric endocrine tumors type I: treatment with long-acting somatostatin analogs

Abstract

Gastric endocrine tumors associated with autoimmune chronic atrophic gastritis (gastric carcinoid type I) are almost exclusively benign lesions with little risk of deep invasion of the gastric parietal wall. For this reason, the role of octreotide in the treatment of these neoplastic lesions is controversial. Nine patients with more than five type I gastric endocrine tumors each !1 cm in size, without invasion of the muscularis propria and with Ki-67 index lower than 3%, were treated with long-acting somatostatin analogs for 12 months. After 6 months and again after 12 months, all the patients underwent upper gastrointestinal (GI) endoscopy with multiple biopsies. The plasma chromogranin A (CgA) levels and the gastrin levels in the serum were also determined. In all patients, the gastric neoplastic lesions disappeared after 12 months of somatostatin analog therapy. We also observed a significant reduction of CgA and gastrin levels at 6 and at 12 months of therapy as compared with the baseline values. We demonstrate that somatostatin analog treatment provokes the pathological regression of type I gastric carcinoids. This therapeutic approach should be considered as a valid option in selected patients with multiple type I gastric endocrine tumors.

Neuroendocrine tumor disease: an evolving landscape

“…As an alternative, SSA therapy has been used. This was associated with regression of these lesions and occasionally reductions in circulating gastrin (Fykse et al 2004, Campana et al 2008, but the effects are short term (w1 year) and disease progression has been noted at 5 years following the termination of therapy (Jianu et al 2011).…”

Gastric neuroendocrine tumors: management and challenges

“…28,29 Limited studies, including a few small prospective studies, have demonstrated regression or complete disappearance of tumors and marked decrease in serum gastrin, lasting up to several years. [30][31][32][33][34][35][36][37][38][39] SSAs (e.g. octreotide and lanreotide) can be considered in cases in which endoscopic resection is not feasible due to extensive multifocal disease, or submucosal/lymph node involvement, as well as recurrent disease after repeated endoscopic resection.…”

Advances in the diagnosis and treatment of gastric neuroendocrine neoplasms

“…For multiple small gastric lesions that are difficult to completely remove under endoscope or lesions that recur repeatedly after endoscopic resection, somatostatin analogs (SSAs) may be used because such drugs can lower serum gastrin, shrink tumors, and reduce relapse (22). Longterm use of SSA is required in patients with type 1 gNET because the disease may recur after the withdrawal of this drug (23).…”