Patterns of Use and Clinical Outcomes with Long-Acting Somatostatin Analogues for Neuroendocrine Tumors: A Nationwide French Retrospective Cohort Study in the Real-Life Setting

Abstract

Introduction: Long-acting somatostatin analogues such as lanreotide autogel (LAN) and octreotide long-acting release (OCT) are recommended as first-line treatment for patients with neuroendocrine tumors (NETs). However, only few real-world studies have compared the two medications. This retrospective, observational cohort study used a French claims database to compare patterns of use with LAN vs. OCT in patients with NETs. Methods: Data on LAN and OCT patterns of use were obtained retrospectively from the National System of Health Data (SNDS), a national French claims database. Patients 18 years of age or older who initiated treatment for NETs between 2009 and 2016, and who received at least six subsequent dispensings of first-line LAN or OCT during the first year of treatment, were included. A subgroup analysis was performed on patients with gastroenteropancreatic (GEP)-NETs. Results: Patients receiving LAN (n = 2327) vs. OCT (n = 2090) had greater median treatment duration (31.8 months vs. 22.1 months, respectively; p \ 0.0001; log-rank test) and were less likely to discontinue treatment; adjusted hazard ratio (HR) 0.74 (95% confidence interval [CI] 0.69-0.80). In year 1, a significantly lower percentage of patients receiving LAN vs. OCT switched treatments (10.4% vs. 22.2%, respectively; p \ 0.0001), received an average monthly dose per trimester above recommended dose (3.0% vs. 7.3%, respectively; p \ 0.0001), and used rescue medication (3.1% vs. 10.0%, respectively; p \ 0.0001). Dispensing of pancreatic enzymes was significantly higher in patients receiving LAN than OCT (16.4% vs. 13.9%, respectively). In the subgroup of patients with GEP-NETs, those receiving LAN (n = 1478) vs. OCT (n = 1278) had greater treatment duration and less treatment discontinuation, switching, dosage above the recommended dose, and rescue medication use, but no significant difference in dispensing of pancreatic enzymes or time to second-line treatment. Conclusion: These real-world data suggest potential clinical and economic advantages of

Treatment Patterns of Long-Acting Somatostatin Analogs for Neuroendocrine Tumors

“…The only 2 lanreotide patients in this study with a second dose escalation during the index treatment (who started on 60 mg, then escalated to 90 mg, followed by 120 mg at 28-day intervals) may have experienced the dose titration as seen in clinical practice, 18 rather than dose escalation. Transition to the Other LA-SSA A lower proportion of patients initiated on lanreotide vs octreotide LAR switched to the other LA-SSA after the end of index treatment in this study (18.9% vs 33.6%; p = .008), which was similar to observations of the Harrow et al study (11.6% vs 24.8%; p < .0001), 7 the Klink et al study (8.3% vs 17%; p = .0243), 12 and the Huynh et al study (18.0% vs 33.9%; statistical significance not assessed). 11 However, limited data are available on the clinical benefit and safety of specific LA-SSA sequences.…”

“…5 Lanreotide (Somatuline® Depot) is available in a prefilled syringe JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH for deep subcutaneous injection at a standard dose of 120 mg every 28 days for gastroenteropancreatic NET. 6 With the approval of lanreotide for gastroenteropancreatic NET in December 2014, clinicians and patients may consider sequencing between LA-SSAs 7,8 or escalating LA-SSA doses to above-label 28-day dose (>30 mg for octreotide LAR and >120 mg for lanreotide) 9,10 to help achieve optimal management of NET. However, real-world evidence for these treatment patterns are limited for lanreotide 9 and across LA-SSA groups, 11,12 focusing mostly on octreotide LAR.…”

Neuroendocrine Neoplasia: From Pathophysiology to Novel Therapeutic Approaches

“…There are only a few real-world studies to compare long-acting formulas of ocreotide with those of lanreotide. One recent, large cohort (based on the national French database) included subjects treated with lanreotide (N = 2327), and it proved to be associated with a higher median therapy duration than that observed for individuals treated with octreotide (N = 2090) as well as a lower rate of drug discontinuation [32]. On the contrary, a similar study included 105 patients receiving one of the two SSAs while being diagnosed with advanced, metastatic, well-differentiated GEP NENs.…”

Satisfaction with injection experience of patients with neuroendocrine tumors enrolled on lanreotide autogel patient support programs: Results from the international HomeLAN survey

“…Because NETs require long-term treatment, 6 easy and efficient treatment delivery is important to optimize outcomes, as is adopting a patient-centered approach to management and empowering patients to engage in self-management, including by providing the option of home administration and, when approved, independent injection. 7,8 Patients receiving LAN may choose to have their medication administered at home, which can facilitate greater patient engagement and empower patients to take more control of their own disease management and care; treatment at home also lessens the travel burden for patients.…”