Somatostatin analogue (SMS 201-995) in the management of gastroenteropancreatic tumors and diarrhea syndromes

Abstract

SMS 201-995 (Sandostatin) was studied using low doses (50 to 100 micrograms) administered subcutaneously every 12 hours. A single 50-micrograms dose of SMS 201-995 effectively controlled gastric acid and blood gastrin levels for 12 hours in three patients with benign gastrinomas and was useful in their perioperative management. Higher doses of the agent (500 to 800 micrograms per day) had no effect on metastases in one of two patients with metastatic gastrinoma. In the other patient, one tumor shrank but the other continued to grow after three months of treatment while serum gastrin levels did not change. Cultured metastatic tumor tissue from this patient released different forms of gastrin; growth rates varied, independent of uptake of SMS 201-995, and gastrin release increased. A neonate with nesidioblastosis maintained normal blood glucose levels while receiving SMS 201-995 therapy following a 95 percent pancreatic resection. In two elderly patients with organic hypoglycemia--one with a single benign adenoma and one with multiple adenomatosis--the somatostatin analogue did not prolong the hypoglycemia-free interval. In nine patients with carcinoid syndrome, flushing was uniformly controlled with 50 micrograms of SMS 201-995 administered every eight to 12 hours. One of the nine required exocrine pancreatic replacement. After six months of treatment, three of the nine had no change in tumor size and one had remission of symptoms and stopped treatment. In two patients with vipoma, SMS 201-995 controlled diarrhea and reduced levels of vasoactive intestinal peptide; tumor necrosis occurred in one patient. In a patient with diabetic diarrhea unresponsive to all treatments, SMS 201-995 therapy controlled the diarrhea but did not interfere with control of the diabetes.

Somatostatin analogues in the control of neuroendocrine tumours: efficacy and mechanisms

“…Administration of SSAs, at variable dosages (from 100 mg twice a day to 200 mg thrice a day for octreotide, 10-30 mg octreotide LAR every 4 weeks or 30 mg depot lanreotide every 10-14 days), may significantly improve symptoms related to the carcinoid syndrome, such as diarrhoea or flushing (between 38 and 88% in different studies); significantly lower levels of urinary hydroxyindoleacetic acid (5-HIAA), the metabolite of serotonin, were also observed in the treated patients (Kvols et al 1986, Vinik et al 1986, Oberg et al 1991, Wymenga et al 1999, Rubin et al 1999, O'Toole et al 2000. In a multicentre study of 33 patients diagnosed with the carcinoid syndrome, treatment with lanreotide (30 mg i.m.…”

Somatostatin analogue scintigraphy in carcinoid tumours

“…Chronic treatment with the somatostatin analogue octreotide (Sandostatin) causes relief of symptoms and a decrease in urinary 5-hydroxyindoleacetic acid (5-HIAA) levels in most patients with the carcinoid syndrome [5][6][7][8].…”

Effects of a Long-Acting Somatostatin Analogue on Pituitary-Adrenocortical Secretion in Normal Human Subjects.

“…For therapeutic purposes, the amounts of SMS that have been used are much greater (Jackson et al, 1986;Vinik et al, 1986) than those tested in the present study and also SMS was injected every 8 to 12 hours for more than a month in many of the studies (Lamberts et al, 1985;Lamberts and Pozo, 1986). Thus, the exact effects of SMS on adrenocortical function in the current therapeutic regimens remains to be established.…”