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Deciding on SSA Treatment in NETs

Insights From: Heloisa P. Soares, MD, UNM Comprehensive Cancer Center; Jonathan R. Strosberg, MD, Moffitt Cancer Center; Timothy J. Hobday, MD, Mayo Clinic College of Medicine and Science
Published: Tuesday, Mar 20, 2018



Transcript: 

Heloisa P. Soares, MD: It’s a very interesting and deep discussion with patients, in terms of how we’re going to decide when to start treatment and how to start treatment. Patients that have a very functional tumor are secreting hormones that you probably want to control. This is easy. You start them on a somatostatin analog, which should improve quality of life by reducing symptoms and will probably prolong survival. For patients that don’t have any functional symptoms and have a tumor that we believe will respond to a somatostatin analog, because either the OctreoScan or the Gallium-68 is positive, you can have a very balanced discussion regarding what is more important. Even though somatostatin analogs are very well tolerated, you can still have some side effects. You can have long-term diarrhea from pancreatic enzyme deficiency. You can have some fatigue. It can alter your sugar levels and other things.

So, for that particular patient who has a very indolent tumor and does not have any symptoms from the tumor, that’s when you can have a very deep discussion with the patient regarding the best time to start treatment. It may be very well accepted to just monitor this patient with scans, for some period of time, before you’re triggering the idea of starting treatment.

In terms of advantages of one over the other, although trials haven’t been done on that, patients have received both. They have definitely said that lanreotide tends to hurt less, because it’s a subcutaneous injection. That’s one of the things that patients have mentioned to me—they feel better with lanreotide. The second issue is that because it’s a ready-to-go injection, they don’t have to mix. The waiting time to get it done is much faster, so patients are in and out of the clinic much faster than with octreotide. But, again, this hasn’t really been compared in a prospective study, to see if these observations from patients are actually real.

Jonathan R. Strosberg, MD: Sandostatin has to be administered intramuscularly. If it’s not injected into the muscle to subcutaneous tissue, the absorption is suboptimal. It still works, to some extent, but it’s uncomfortable for patients. It leaves a lump, and the control of the syndrome is not quite as strong.

Somatuline is meant to be administered as a deep subcutaneous injection. It comes in a prefilled syringe, so it’s actually a bit easier for nurses to administer. It’s more efficient. And if it happens to go into the muscle, the absorption is similar. So, I would characterize the administration of Somatuline as a little bit easier than that of Sandostatin. Whether patients have a preference for one drug versus the other is really hard to say.

Transcript Edited for Clarity 
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Transcript: 

Heloisa P. Soares, MD: It’s a very interesting and deep discussion with patients, in terms of how we’re going to decide when to start treatment and how to start treatment. Patients that have a very functional tumor are secreting hormones that you probably want to control. This is easy. You start them on a somatostatin analog, which should improve quality of life by reducing symptoms and will probably prolong survival. For patients that don’t have any functional symptoms and have a tumor that we believe will respond to a somatostatin analog, because either the OctreoScan or the Gallium-68 is positive, you can have a very balanced discussion regarding what is more important. Even though somatostatin analogs are very well tolerated, you can still have some side effects. You can have long-term diarrhea from pancreatic enzyme deficiency. You can have some fatigue. It can alter your sugar levels and other things.

So, for that particular patient who has a very indolent tumor and does not have any symptoms from the tumor, that’s when you can have a very deep discussion with the patient regarding the best time to start treatment. It may be very well accepted to just monitor this patient with scans, for some period of time, before you’re triggering the idea of starting treatment.

In terms of advantages of one over the other, although trials haven’t been done on that, patients have received both. They have definitely said that lanreotide tends to hurt less, because it’s a subcutaneous injection. That’s one of the things that patients have mentioned to me—they feel better with lanreotide. The second issue is that because it’s a ready-to-go injection, they don’t have to mix. The waiting time to get it done is much faster, so patients are in and out of the clinic much faster than with octreotide. But, again, this hasn’t really been compared in a prospective study, to see if these observations from patients are actually real.

Jonathan R. Strosberg, MD: Sandostatin has to be administered intramuscularly. If it’s not injected into the muscle to subcutaneous tissue, the absorption is suboptimal. It still works, to some extent, but it’s uncomfortable for patients. It leaves a lump, and the control of the syndrome is not quite as strong.

Somatuline is meant to be administered as a deep subcutaneous injection. It comes in a prefilled syringe, so it’s actually a bit easier for nurses to administer. It’s more efficient. And if it happens to go into the muscle, the absorption is similar. So, I would characterize the administration of Somatuline as a little bit easier than that of Sandostatin. Whether patients have a preference for one drug versus the other is really hard to say.

Transcript Edited for Clarity 
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