Somatostatin Analogues Do Not Prevent Carcinoid Crisis

Abstract

Background: Carcinoid crisis is a life-threating syndrome of neuroendocrine tumors (NETs) characterized by dramatic blood pressure fluctuation, arrhythmias, and bronchospasm. In the era of booming anti-tumor therapeutics, this has become more important since associated stresses can trigger carcinoid crisis. Somatostatin analogues (SSTA) have been recommended for prophylactic administration before intervention procedures for functioning NETs. However, the efficacy is still controversial. The aim of this article is to review efficacy of SSTA for preventing carcinoid crisis. Materials and Methods: PubMed, Cochrane Controlled trials Register, and EMBASE were searched using 'carcinoid crisis' as a search term combining terms with 'somatostatin'; 'octreotide'; 'lanreotide' and 'pasireotide' until December 2013. Results: Twenty-eight articles were retrieved with a total of fifty-three unique patients identified for carcinoid crisis. The most common primary sites of NETs were the small intestine and respiratory tract. The triggering factors for carcinoid crisis included anesthesia/ surgery (63.5%), interventional therapy (11.5%), radionuclide therapy (9.6%), examination (7.7%), medication (3.8%), biopsy (2%) and spontaneous (2%). No randomized controlled trials (RCTs) were identified and two case-control studies were included to assess the efficacy of SSTA for preventing carcinoid crisis by meta-analysis. The overall pooled risk of perioperative carcinoid crisis was similar despite the prophylactic administration of SSTA (OR 0.44, 95% CI: 0.14 to 1.35, p=0.15). Conclusions: SSTA wasnot helpful for preventing carcinoid crisis based on a meta-analysis of retrospective studies. Attentive monitoring and careful intervention are essential. Future studies with better quality are needed to clarify any effect of SSTA for preventing carcinoid crisis.

Expectations of Response from Octreotide Therapy in Recurrent Phosphaturic Mesenchymal Tumors - Do They Reflect Reality?

“…As previously reported for neuroendocrine tumors, heterogenous distribution of somatatostatin receptors between tumor cells and hence higher number of cells lacking somatostatin receptors may have influenced treatment results (Wynick D et al, 1989). However, in a meta analysis has shown that the efficacy of somatostatin analogue octreotide treatment for preventing carcinoid crisis remains controversial (Guo and Tang, 2014).…”

Fatal Systemic Vasoconstriction in a Case of Metastatic Small-Intestinal NET

“…Based on these observations, (pre)treatment with octreotide is recommended for therapeutic interventions in functional midgut NET. Although some drugs have been successfully used in certain cases, for example, cyproheptadine, ketanserin, 5-HT receptor antagonists, corticosteroids, and H1- and H2-receptor antagonists [ 15 ], somatostatin analogues are considered most effective and are recommended as first-line therapy [ 8 , 9 , 26 ].…”

“…An excessive release of these active substances caused by different triggers like surgery/anaesthesia, interventional diagnostic and therapy, radionuclide therapy, medication, and examination can lead to carcinoid crisis characterized by dramatic blood pressure fluctuation, arrhythmias, bronchospasm, and mental disturbances [ 8 – 13 ]. Commonly, hypotension is the expected hemodynamic change; however a small group of carcinoid patients experiences hypertension during carcinoid crisis [ 14 , 15 ].…”

Cases in a series of carcinoid syndrome and carcinoid heart disease

“…Peri-operative management: the surgical approach for CHD patients requires a highly skilled multidisciplinary team with broad experience, as anaesthesia can trigger carcinoid crisis and subsequent death in patients going for surgery. 26,[40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57] The most crucial pre-operative anaesthetic management should encompass optimum control of carcinoid symptoms, and intensified and close monitoring of intra-operative blockade of serotonin receptors. Drugs that may stimulate the release of vasoactive substances from tumour cells should be avoided.…”

“…Drugs that may stimulate the release of vasoactive substances from tumour cells should be avoided. 26,[40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57] The most important drugs to be avoided during the peri-operative period include histamine-releasing neuromuscular relaxants and opioids, as they are associated with detrimental outcomes in CHD patients. The introduction of somatostatin analogues remains a key component to prevent peri-operative carcinoid crisis, and the administration of larger doses of somatostatin analogue is highly recommended in CHD patients.…”