Long-Term Disease Control of a Pancreatic Neuroendocrine Tumor with Lanreotide Autogel®: A Case Report

Abstract

The CLARINET study (ClinicalTrials.gov: NCT00353496) showed that somatostatin analogs are able to stabilize tumor growth in patients with intestinal and pancreatic neuroendocrine tumors (NETs). Here, we present a case of NET originating from the pancreatic tail that was treated with lanreotide Autogel®. A 60-year-old patient underwent resection of a pancreatic NET with splenectomy and distal pancreatectomy. Four months after surgery, there was an increase in chromogranin A levels, along with a hypercaptating lesion of approximately 3.5 cm at the residual part of the pancreatic corpus. Treatment with 30 mg monthly-administered octreotide long-acting release (LAR) was initiated. After 3 months of treatment, a control CT scan revealed diffuse metastases in the liver, although the patient presented no symptoms and liver tests were normal. Due to difficulties with the administration of octreotide LAR, treatment was switched to lanreotide Autogel® 120 mg, administered as monthly deep-subcutaneous injections. Progression-free survival, as shown by 3-monthly CT scans, was obtained for 2 years without the need to increase the lanreotide Autogel® dose, and the patient reported no side effects. After these 2 years, deterioration of the patient's clinical status and weight loss were observed, along with increased size of the liver lesions and appearance of peritoneal metastases. Chemotherapy treatment with cisplatinum-etoposide was initiated, while the lanreotide Autogel® injections were continued. After three chemotherapy cycles, a rapid decline in the patient's quality of life was noted, and she requested discontinuation of the chemotherapy and lanreotide injections. One month later, the patient died due to clinical progressive disease.

The Antiproliferative Role of Lanreotide in Controlling Growth of Neuroendocrine Tumors: A Systematic Review

“…The results from the PubMed database and congress abstract search and screening are presented in Figure . The review consisted of 40 publications, including 27 full‐length publications and 13 congress abstracts (Tables and ) . Thirty‐six (90%) of the publications reported on studies performed in Europe, three involved centers in Europe, the U.S., and India (including the two subgroup analyses studies and an open‐label extension [OLE] study from the core CLARINET study), one was performed in the U.S., and one was performed in Israel.…”

ENETS Conference for the Diagnosis and Treatment of Neuroendocrine Tumor Disease

“…by assessing the uptake of 68 Ga-DOT-ATATE in 105 patients with NETs, 35 of whom had been pretreated with octreotide LAR. 5 The maximum stan-dardized uptake value (SUV max ) was significantly reduced in the liver and spleen of the pretreated patients (P<.001). The SUV max in primary tumors did not differ according to pretreatment with octreotide LAR.…”

“…The rates of discontinuation due to treatment-emergent adverse reactions were 5% (5/101 patients) in the SOMATULINE DEPOT arm and 3% (3/103 patients) in the placebo arm. 4 14* 0 5 0 Hypertension 5 14* 1* 5 0 Cholelithiasis 14* 1* 7 0 Dizziness 9 0 2* 0 Depression 6 7 0 1 0 Dyspnea 6 0 1 0 1 Includes preferred terms of abdominal pain, abdominal pain upper/lower, abdominal discomfort 2 Includes preferred terms of myalgia, musculoskeletal discomfort, musculoskeletal pain, back pain 3 Includes preferred terms of infusion site extravasation, injection site discomfort, injection site granuloma, injections site hematoma, injection site hemorrhage, injection site induration, injection site mass, injections site nodule, injection site pain, injection site pruritus, injection site rash, injection site reaction, injection site swelling. 4 Includes preferred terms of diabetes mellitus, glucose tolerance impaired, hyperglycemia, type 2 diabetes mellitus 5 Includes preferred terms of hypertension, hypertensive crisis 6 Includes preferred terms of depression, depressed mood * Includes one or more serious adverse events (SAEs) defined as any event that results in death, is life threatening, results in hospitalization or prolongation of hospitalization, results in persistent or significant disability, results in congenital anomaly/birth defect, or may jeopardize the patient and may require medical or surgical intervention to prevent one of the outcomes listed.…”

“…4 A phase 3 study of patients with metastatic renal cell carcinoma demonstrated an independent association between TGR and PFS as well as overall survival (OS). 5 The phase 3 CLARINET (Controlled Study of Lanreotide Antiproliferative Response in Neuroendocrine Tumors) study demonstrated the efficacy and safety of lanreotide depot/ autogel in patients with intestinal and pancreatic NETs. 6 The international, randomized, double-blind, placebocontrolled study enrolled 204 patients with nonfunctional, well or moderately differentiated tumors with demonstrated somatostatin receptor expression and metastatic disease.…”

“…4 Data from case reports have suggested that patients who progress on octreotide can achieve benefit from lanreotide depot/autogel and vice versa. 5,6 In the current healthcare environment, cost-effectiveness is a key driver of decision-making. The study by Dr Ortendahl found that in 64% of patients, octreotide was administered at 30 mg once every 4 weeks.…”