Treatment of malignant insulinoma with streptozotocin

Abstract

Two patients with malignant insulinoma and hepatic metastases were treated with streptozotoein, administered directly into the celiac artery. Decreases in tumor size were documented radiographically. One patient was in a terminal state when first treated, but the other patient was in moderately good general health and responded well. Some side-effects, including renal tubular damage, were observed but were relatively minor. Streptozotocin therapy offers some benefit in patients ~vith malignant insulinoma. Traitement de l'insulinome malin par la streptozotocine Rdsumd. Deux patients attcints d'insulinome avec m6tastases h@atiques ont 6t6 trait@s par injection de streptozotoeinc darts l'artgre coeliaque. Une diminution des dimensions de la tumcur a 6t6 mise en 6vidence radiologiquement. L' un des patients trait dans un 6tat ferminal au moment o~ le traitement a 6t6 institu6; l'autre patient dent l'@tat g@n6ral ~tait relativement ben a bien r6pondu ~ la th6rapeutique. Certains effets eollatdraux dent des signes d'attcinte r6nale tubulaire, ont 6t6 not6s mais sent relativement peu importants. La streptozotocine offrc done un certain inter6t dans le traitement de l'insulinomc malin. Die Behandlung des maligne~ Insulinoms mit Streptozotocin Zusammenfassung. Zwei Patienten mit metastasiercndem Insulinom wurde Streptozotozin in die Arteria cocliaca verabrcieht. Daraufhin liel3 sich radiographisch ein Riiekgang der TumorgrSl3e nachweiscn. Bei Therapiebeginn bcfand sich ein Patient in m/~l]igem, dcr andere in schr schlechtem Allgcmcinzustand. Einige Nebenwirkungcn, insbcsondere Sch/idigung der Nierentubuli, traten auf, waren abet yon geringem Ausmal3. Streptozotozin ist geeignet, Patienten, die an einem malignen Insulinom leiden, Gin@rung zu verschaffen.

Streptozotocin, 1982–2022: Forty Years from the FDA’s Approval to Treat Pancreatic Neuroendocrine Tumors

“…Insulinoma was one of the first panNETs treated with STZ [35][36][37][38][39][40][41][42]. By way of a historical report, we will comment on the case reported by Arnould et al [36] in 1969 in The Lancet.…”

Treatment of Malignant Metastatic Pancreatic Insulinoma with Streptozotocin

“…2) Intra-arterial administration to the coeliac axis via the aorta must be avoided, since part of the injected drug reaches the renal arteries and causes severe renal damage, i.e. acute tubular necrosis (13,17,18). All these cases with severe renal damage received high total doses of streptozotocin, 15-36 g. The survival period in these reports varied between 7 days and 4 months.…”

“…In addition to the more common symptoms and signs, the following features were noted: high serum gash-in and glucagon values (10, 1 l), pathological liver enzyme activities (2,7,16), gastric or duodenal peptic ulcer (5, 10, 13), watery diarrhoea (7, ll), multiple endocrine adenomatosis in a 6-year-old child. This patient developed an active insulinoma with a tumour, severe obesity and vinlization (17). Diabetes mellitus was the activating factor in one case 3 years before the development of the malignant tumour (6).…”

“…There were various causes of death. Death was probably accelerated by (a) additional infusion of 5-fluorouracil ( 5 , 13), (b) high total doses of streptozotocin (18-30 g) or very frequent, large amounts of the drug (6,13,15,17), ( c ) perforation of a duodenal ulcer (10); finally ( d ) high doses in 2 cases (13.5-36 g) resulted in severe diabetes insipidus (10,17). 5 , , ,…”