Management of a metastasized high grade insulinoma (G3) with refractory hypoglycemia: Case report and review of the literature

Scharf, Michael E.; Mueller, Daniela; Koenig, Ute; Pfestroff, Andreas; Nimphius, Wilhelm; Figiel, Jens; Rinke, Anja; Köenig, Alexander; Gress, Thomas M.

doi:10.1016/j.pan.2014.07.011

Cited by 11 publications

(7 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[10] Somatostatin analogues (Octreotide, Lanreotide), chemotherapy, and everolimus can also provide normoglycemic periods. [11] However, in our case, treatment with Diazoxide and Octreotide did not lead to sufficient reduction of symptoms. SIRT with 90Yttrium (90Y) ▶ Fig.…”

Section: Discussioncontrasting

confidence: 68%

See 1 more Smart Citation

Case report – Selective internal radiation therapy (SIRT) in a patient with hyperinsulinemic hypoglycemia due to a metastatic insulinoma with late onset of endocrine activity

2022

View full text Add to dashboard Cite

Insulinomas are the most common functioning pancreatic neuroendocrine tumors (NET), which can lead to hyperinsulinemic hypoglycemia. In advanced metastatic stages of the disease, the prognosis is poor. Patients with hormonally active insulinomas primarily present with features of neuroglycopenia. Transformation from a nonfunctional to a functional NET is rare. Here, we present a case of a 59-year-old male adult with a metastatic insulinoma and late onset of endocrine activity. Besides medical treatment with Diazoxide and small frequent feedings, continuous intravenous glucose application was eventually required to avoid hypoglycemia. Furthermore, we show that selective internal radiation therapy (SIRT) can be an effective therapeutic approach for symptom reduction in advanced metastatic disease.

show abstract

Section: Discussioncontrasting

confidence: 68%

“…[10] Somatostatin analogues (Octreotide, Lanreotide), chemotherapy, and everolimus can also provide normoglycemic periods. [11] However, in ▶ Fig. 1 PET-CT with hepatic filiae in both hepatic lobes.…”

Section: Discussionmentioning

confidence: 94%

Case report – Selective internal radiation therapy (SIRT) in a patient with hyperinsulinemic hypoglycemia due to a metastatic insulinoma with late onset of endocrine activity

2022

View full text Add to dashboard Cite

show abstract

“…Although multiple series [22–25] have documented the use of SSAs among patients with G3 NETs, this is, to our knowledge, the first study to formally report the survival outcomes associated with SSAs in an albeit small cohort of patients with well‐differentiated, G3 panNETs. The rationale to treat patients with G3 panNETs with somatostatin‐based therapies relies on the expression of somatostatin receptors, which has been described in small series to occur in up to 80% of G3 GEP‐NETs [26, 27].…”

Section: Discussionmentioning

confidence: 99%

Somatostatin Analogs for Pancreatic Neuroendocrine Tumors: Any Benefit When Ki-67 Is ≥10%?

et al. 2020

View full text Add to dashboard Cite

Background Long‐acting somatostatin analogs (SSAs) are the primary first‐line treatment of well‐differentiated advanced gastroenteropancreatic neuroendocrine tumors (NETs), but data about their efficacy in pancreatic NETs (panNETs) with Ki‐67 ≥10% are still limited. Materials and Methods To assess the clinical outcomes of advanced, nonfunctioning, well‐differentiated panNETs with Ki‐67 ≥10% receiving first‐line long‐acting SSAs in a real‐world setting, we carried out a retrospective, multicenter study including patients treated between 2014–2018 across 10 centers of the NET CONNECT Network. The primary endpoints were time to next treatment (TNT) and progression‐free survival (PFS), whereas overall survival (OS) and treatment safety were secondary endpoints. Results A total of 73 patients were included (68 grade [G]2, 5 G3), with liver metastases in 61 cases (84%). After a median follow‐up of 36.4 months (range, 6–173), the median TNT and PFS were 14.2 months (95% confidence interval [CI], 11.6–16.2) and 11.9 months (95% CI, 8.6–14.1) respectively. No statistically significant difference was observed according to the somatostatin analog used (octreotide vs. lanreotide), whereas increased tumor grade (hazard ratio [HR], 4.4; 95% CI, 1.2–16.6; p = .04) and hepatic tumor load (HR, 2; 95% CI, 1–4; p = .03) were independently associated with shortened PFS. The median OS recorded was 86 months (95% CI, 56.8–86 months), with poor outcomes observed when the hepatic tumor burden was >25% (HR, 3.4; 95% CI, 1.2–10; p = .01). Treatment‐related adverse events were reported in 14 patients, most frequently diarrhea. Conclusion SSAs exert antiproliferative activity in panNETs with Ki‐67 ≥10%, particularly in G2 tumors, as well as when hepatic tumor load is ≤25%. Implications for Practice The results of the study call into question the antiproliferative activity of somatostatin analogs (SSAs) in pancreatic neuroendocrine tumors with Ki‐67 ≥10%. Patients with grade 2 tumors and with hepatic tumor load ≤25% appear to derive higher benefit from SSAs. Prospective studies are needed to validate these results to optimize tailored therapeutic strategies for this specific patient population.

show abstract

“…Inhibition of mTOR pathway was reported to attenuate insulin secretion in an insulinoma cell line[120]. Furthermore, everolimus controlled hypoglycemic symptoms in patients with insulinomas[103,121,121–127]. …”

Section: Efficacy Of Everolimusmentioning

confidence: 99%

Everolimus in the treatment of neuroendocrine tumors: efficacy, side-effects, resistance, and factors affecting its place in the treatment sequence

Lee

Ito

Jensen

2018

Expert Opinion on Pharmacotherapy

View full text Add to dashboard Cite

Introduction: Since the initial approval of everolimus in 2011, there have been a number of important changes in therapeutic/diagnostic modalities as well as classification/staging systems of neuroendocrine tumors (NETs), which can significantly impact the use of everolimus in patients with advanced NETs. Areas covered: The efficacy of everolimus monotherapy and combination therapy demonstrated in clinical studies involving patients with advanced NETs are reviewed. Several factors affecting everolimus’ use are described including: the development and routine use of NET classification/staging systems; widespread use of molecular imaging modalities; side-effects; drug resistance; and the availability of other treatment options. Furthermore, the current position of everolimus in the treatment approach is discussed, taking into account the recommendations from the recent guidelines. Expert opinion: Although everolimus demonstrated its high efficacy and tolerability in the RADIANT trials and other clinical studies, there still remain a number of controversies related to everolimus treatment in the management of NETs. The synergistic anti-growth effect of other agents in combination with everolimus or its effect on overall survival have not been established. The appropriate order of the use of everolimus in the treatment of advanced NETs still remains unclear, which needs to be defined in further studies and will be addressed in the new guidelines.

show abstract

Management of a metastasized high grade insulinoma (G3) with refractory hypoglycemia: Case report and review of the literature

Cited by 11 publications

References 15 publications

Case report – Selective internal radiation therapy (SIRT) in a patient with hyperinsulinemic hypoglycemia due to a metastatic insulinoma with late onset of endocrine activity

Case report – Selective internal radiation therapy (SIRT) in a patient with hyperinsulinemic hypoglycemia due to a metastatic insulinoma with late onset of endocrine activity

Somatostatin Analogs for Pancreatic Neuroendocrine Tumors: Any Benefit When Ki-67 Is ≥10%?

Everolimus in the treatment of neuroendocrine tumors: efficacy, side-effects, resistance, and factors affecting its place in the treatment sequence

Contact Info

Product

Resources

About