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Role of Somatostatin Analogs in Neuroendocrine Tumors

Panelists: Matthew H. Kulke, MD, Dana-Farber; Pamela L. Kunz, MD, Stanford; Rodney F. Pommier, MD, OHSU; James C. Yao, MD, MD Anderson
Published: Monday, Apr 08, 2013
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The surgical resection of neuroendocrine tumors (NETs) often alleviates many of the symptoms caused by NET-related hormone hypersecretion. However, in addition to surgery, somatostatin analogs can be administered to alleviate these symptoms.

In his research, Rodney F. Pommier, MD, notes that the rate of carcinoid crisis was much higher than initially believed, at nearly 30%. Due to this increased risk of crisis during surgery, Pommier recommends administering somatostatin analogs followed by a period of observation prior to surgery. In the adjuvant setting, data does not support continued treatment.

James C. Yao, MD, describes the PROMID trial that examined octreotide LAR in patients with small bowel carcinoids. This trial showed that treatment with octreotide LAR significantly delayed time to progression. In general, Yao believes the benefits of treatment with somatostatin analogs outweighs the risks and warrants its administration in most cases. Despite this, Yao notes, an analysis of the linked SEER-Medicare database found that treatment with somatostatin analogs is widely under utilized.

Due to side effects, Pamela L. Kunz, MD, believes that only patients who will benefit the most should receive treatment with somatostatin analogs. She discourages the empirical use of these agents before surgery and feels they do not have a role in the adjuvant setting.

A common side effect of somatostatin analog therapy is cholelithiasis, warranting an assessment of a need for long-term therapy. Pommier notes that if long-term therapy is required and an abdominal surgery is planned it may be wise to perform a cholecystectomy. However, Pommier notes, this procedure should be individualized based on the primary site and risks associated with each tumor.
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For High-Definition, Click
The surgical resection of neuroendocrine tumors (NETs) often alleviates many of the symptoms caused by NET-related hormone hypersecretion. However, in addition to surgery, somatostatin analogs can be administered to alleviate these symptoms.

In his research, Rodney F. Pommier, MD, notes that the rate of carcinoid crisis was much higher than initially believed, at nearly 30%. Due to this increased risk of crisis during surgery, Pommier recommends administering somatostatin analogs followed by a period of observation prior to surgery. In the adjuvant setting, data does not support continued treatment.

James C. Yao, MD, describes the PROMID trial that examined octreotide LAR in patients with small bowel carcinoids. This trial showed that treatment with octreotide LAR significantly delayed time to progression. In general, Yao believes the benefits of treatment with somatostatin analogs outweighs the risks and warrants its administration in most cases. Despite this, Yao notes, an analysis of the linked SEER-Medicare database found that treatment with somatostatin analogs is widely under utilized.

Due to side effects, Pamela L. Kunz, MD, believes that only patients who will benefit the most should receive treatment with somatostatin analogs. She discourages the empirical use of these agents before surgery and feels they do not have a role in the adjuvant setting.

A common side effect of somatostatin analog therapy is cholelithiasis, warranting an assessment of a need for long-term therapy. Pommier notes that if long-term therapy is required and an abdominal surgery is planned it may be wise to perform a cholecystectomy. However, Pommier notes, this procedure should be individualized based on the primary site and risks associated with each tumor.
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