The Never-Ending History of Octreotide in Thymic Tumors: A Vintage or A Contemporary Drug?

Abstract

Thymic epithelial tumors are rare tumors usually presenting as a mass located in the anterior mediastinum and/or with symptoms deriving from associated paraneoplastic syndromes. Unresectable platinum-refractory tumors are often treated with alternative regimens, including chemotherapeutic agents as well as chemo-free regimens. The most popular unconventional therapy is represented by the somatostatin analog octreotide, which can be used alone or with prednisone. The in vivo expression of somatostatin receptors documented by imaging with indium-labeled octreotide or gallium-68 Dotapeptides, the successful use of octreotide and prednisone in a chemo-refractory patient, and, thereafter, the experiences from a case series have enforced the idea that this treatment merits consideration—as proved by its inclusion in the National Comprehensive Cancer Network guidelines. In the present review, we analyze the preclinical basis for the therapeutic use of somatostatin and prednisone in refractory thymic tumors and discuss the available studies looking at future perspectives.

A Case of Metastatic Thymoma Responsive to Treatment With 177Lu-DOTATATE

“…Treatment mainstay is surgery for resectable disease, and chemotherapy followed by targeted therapies such as everolimus and sunitinib for inoperable thymomas 2 . Some thymoma tumor cells express somatostatin receptors, 3,4 also reflected by avidity to radiolabeled octreotide derivative scintigraphy (both 111 In-octreotide SPECT/CT [Octreoscan] 5 and 68 Ga-DOTA-octreotate [DOTATATE] PET/CT) 6 . Targeted treatment with “cold” octreotide as a neoadjuvant treatment, with or without prednisone, reduced thymoma tumor size in several cases, allowed complete tumor resection, 7,8 and is currently reserved as second-line treatment 5 .…”

“…6 Targeted treatment with "cold" octreotide as a neoadjuvant treatment, with or without prednisone, reduced thymoma tumor size in several cases, allowed complete tumor resection, 7,8 and is currently reserved as second-line treatment. 5 Peptide receptor radionuclide therapy (PRRT) with radiolabelled somatostatin analogs ( 177 Lu-DOTATATE) is standard-of-care therapy for unresectable 68 Ga-DOTATATE-avid neuroendocrine neoplasms of gastroenteropancreatic origin. 9 However, little is known regarding the efficacy of PRRT in patients with metastatic or locally advanced thymomas.…”

“…Some thymoma tumor cells express somatostatin receptors, 3,4 also reflected by avidity to radiolabeled octreotide derivative scintigraphy (both 111 In-octreotide SPECT/CT [Octreoscan] 5 and 68 Ga-DOTA-octreotate [DOTATATE] PET/CT) 6 . Targeted treatment with “cold” octreotide as a neoadjuvant treatment, with or without prednisone, reduced thymoma tumor size in several cases, allowed complete tumor resection, 7,8 and is currently reserved as second-line treatment 5 . Peptide receptor radionuclide therapy (PRRT) with radiolabelled somatostatin analogs ( 177 Lu-DOTATATE) is standard-of-care therapy for unresectable 68 Ga-DOTATATE–avid neuroendocrine neoplasms of gastroenteropancreatic origin 9 .…”