Abstract
Objective: To examine patients with metastatic gastroenteropancreatic neuroendocrine tumors (GEP-NETs) who receive sequential treatment with somatostatin analogs.Materials and Methods: This retrospective chart review examined lanreotide depot/autogel tolerability and efficacy among GEP-NET patients who received lanreotide after octreotide long-acting release (LAR) at Tufts University Medical Center. Information obtained included background patient characteristics, dosing, adverse events (AEs), radiologic response, and biochemical markers.Results: Patients (n = 16; 43–81 years; mean age, 64.25 years; 11 female) with nonfunctional, low-grade GEP-NETs receiving octreotide LAR 30–60 mg were transitioned to lanreotide because of patient decision (n = 6), disease progression (n = 6), AEs (n = 2), poor tolerance (n = 1), and injection discomfort/pain (n = 1). Lanreotide doses started at 120 mg (n = 13), 90 mg (n = 1), or 60 mg (n = 2); 8 patients received concomitant therapies, mostly liver-directed (radiofrequency ablation/radioembolization). AEs associated with lanreotide experienced by ≥2 patients were fatigue, diarrhea, nausea, hypertension, pancreatic enzyme deficiency, and hyperglycemia. Radiologic treatment responses of the combination of lanreotide with other therapeutic modalities included complete response (n = 1), partial response (n = 5), and stable disease (n = 9). One patient had radiologic progression. Serum serotonin and chromogranin levels decreased, but urinary 5-hydroxyindoleacetic acid levels appeared relatively unchanged.Conclusion: Among post-octreotide GEP-NET patients, including those with disease progression or poor octreotide tolerance, lanreotide alone or with concomitant therapies was well tolerated and associated with radiologic responses.
Highlights
The incidence of neuroendocrine tumors (NETs) has increased markedly in the United States over the past several decades
The results showed that octreotide long-acting release (LAR; n = 42) stabilized tumor growth, prolonged time to tumor progression, and improved long-term survival compared with placebo (n = 43).[10]
(September 2017), the same dosage was approved by the Food and Drug Administration (FDA) for the treatment of carcinoid syndrome in adults to reduce the frequency of short-acting somatostatin analogs (SSAs) rescue therapy.[11]. The objectives of this case series included assessing the safety, tolerability, and efficacy of lanreotide in patients with various GEP-NETs who were previously treated with octreotide LAR
Summary
The incidence of neuroendocrine tumors (NETs) has increased markedly in the United States over the past several decades. The U.S Surveillance, Epidemiology, and End Results (SEER) database, for example, shows a 6.4-fold increase in NETs from 1973 to 2012 (1.09– 6.98 per 100,000 persons).[1] For gastroenteropancreatic neuroendocrine tumors (GEP-NETs), the overall incidence was 3.56 per 100,000 persons between 2000 and 2012. Across all NET patients, median overall survival was the highest for NETs in the appendix (>30 years) and rectum (24.6 years), while NETs in the pancreas showed the lowest median survival (3.6 years).[1]. Departments of 1Medical Oncology, 2Pathology, and 3Invasive Radiology, Tufts Cancer Center–Tufts Medical Center, Boston, Massachusetts. A portion of these results were presented at the North American Neuroendocrine Tumor Society Symposium, September 30–October 1, 2016, Jackson, WY.
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