Is Octreotide Useful for Hepatic Metastases Due to Non-Neuroendocrine Primary Tumors?
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Cited by 2 publications
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K Pistevou-Gombaki et al.1,2 presented their positive experience from the palliative use of octreotide LAR in hepatic metastases from non-neuroendocrine tumors. On the other hand, there are several negative prospective studies of octreotide effi cacy in liver metastases and this policy is not accepted from al oncologists. 3,4 According to this literature controversy and in continuation to the above-mentioned studies, we would like to report our recent experience from the effi cient use of octreotide LAR in seven patients with symptomatic liver metastases from non-neuroendocrine tumors and in one female (80-years-old) with duodenal carcinoid.Somatostatin has been shown to possess antimitotic activity against non-endocrine tumours, while octreotide, a somatostatin analogue, has shown considerable antitumor activity on animal models of various hepatic tumors. A possible antitumor mechanism of octreotide is a stimulatory effect on Kupffer cells, induction of apoptosis or other antiproliferative actions, which have been suggested but not proved. 5,6 Furthermore, somatostatin and its long-acting analogues are effective in symptom control in patients with advanced neuroendocrine gastrointestinal tumours. 7,8 Kouroumalis et al. reported a signifi cant effi cacy of octreotide for the management of hepatocellular carcinoma.9 Kapadia commenting on the improvement of quality of life after the administration of octreotide in patients with hepatocellular carcinoma, reported that the possible mechanism of this, should be the diminishing of the effects of various humoral agents and/or cytokines released from the tumor.10 However, the possible role of octreotide in palliative treatment of symptomatic liver metastases from non-neuroendocrine primary carcinomas remains controversial in the literature.We report on seven patients, (3 females, 4 males), age: (63, 70, 71, 75, 72, 80, 81 years-old), with symptomatic liver metastases from different primary tumors -two from unknown primary origin, four from primary pancreatic carcinoma (two in the head and two in the tail of the pancreas) and one from duodenal carcinoid tumor-, who were palliatively treated by long acting octreotide IM (octreotide LAR) monthly, according to schema published previously. 2In all patients multiple liver metastases in both liver lobes were demonstrated, either by abdominal echosonography, computed-tomography (CT), magnetic resonance imaging (MRI) or a combination of them. In four patients pancreatic tumor in the head (two patients) and in the tail (two patients) of the pancreas was demonstrated. In two patients no primary tumor was found despite meticulous examination in general hospital with chest X-ray, abdominal echosonography, computed-tomography (CT), magnetic resonance imaging (MRI), gastroscopy, colonoscopy and urological examination. In one female, 80-years-old, a duodenal polypoid tumor, more than 5 cm, was found and histological examination was suitable of carcinoid tumor.Clinical examination revealed slight enlarged liver in fi ve patients and sev...
K Pistevou-Gombaki et al.1,2 presented their positive experience from the palliative use of octreotide LAR in hepatic metastases from non-neuroendocrine tumors. On the other hand, there are several negative prospective studies of octreotide effi cacy in liver metastases and this policy is not accepted from al oncologists. 3,4 According to this literature controversy and in continuation to the above-mentioned studies, we would like to report our recent experience from the effi cient use of octreotide LAR in seven patients with symptomatic liver metastases from non-neuroendocrine tumors and in one female (80-years-old) with duodenal carcinoid.Somatostatin has been shown to possess antimitotic activity against non-endocrine tumours, while octreotide, a somatostatin analogue, has shown considerable antitumor activity on animal models of various hepatic tumors. A possible antitumor mechanism of octreotide is a stimulatory effect on Kupffer cells, induction of apoptosis or other antiproliferative actions, which have been suggested but not proved. 5,6 Furthermore, somatostatin and its long-acting analogues are effective in symptom control in patients with advanced neuroendocrine gastrointestinal tumours. 7,8 Kouroumalis et al. reported a signifi cant effi cacy of octreotide for the management of hepatocellular carcinoma.9 Kapadia commenting on the improvement of quality of life after the administration of octreotide in patients with hepatocellular carcinoma, reported that the possible mechanism of this, should be the diminishing of the effects of various humoral agents and/or cytokines released from the tumor.10 However, the possible role of octreotide in palliative treatment of symptomatic liver metastases from non-neuroendocrine primary carcinomas remains controversial in the literature.We report on seven patients, (3 females, 4 males), age: (63, 70, 71, 75, 72, 80, 81 years-old), with symptomatic liver metastases from different primary tumors -two from unknown primary origin, four from primary pancreatic carcinoma (two in the head and two in the tail of the pancreas) and one from duodenal carcinoid tumor-, who were palliatively treated by long acting octreotide IM (octreotide LAR) monthly, according to schema published previously. 2In all patients multiple liver metastases in both liver lobes were demonstrated, either by abdominal echosonography, computed-tomography (CT), magnetic resonance imaging (MRI) or a combination of them. In four patients pancreatic tumor in the head (two patients) and in the tail (two patients) of the pancreas was demonstrated. In two patients no primary tumor was found despite meticulous examination in general hospital with chest X-ray, abdominal echosonography, computed-tomography (CT), magnetic resonance imaging (MRI), gastroscopy, colonoscopy and urological examination. In one female, 80-years-old, a duodenal polypoid tumor, more than 5 cm, was found and histological examination was suitable of carcinoid tumor.Clinical examination revealed slight enlarged liver in fi ve patients and sev...
Letter to the Editor Cholangiocarcinoma is a dismal tumor, diffi cult to treat and in the majority of cases surgery is the only available method of cure, however only in early stages. 1 In advanced cases (turmors Klatskin III and IV) palliative therapy with endoscopic drainage of bile ducts is the only effective and acceptable method of treatment. 2 Adjuvant palliative therapies either with radiotherapy or chemotherapy in order to stabilize the disease gave controversial results and in some aspect unacceptable. 1-2 The need for new treatment to stabilize the disease, increase survival with acceptable quality of life is urgent. Somatostatin and its long-acting analogues have been successfully used in symptom control in patients with advanced neuroendocrine gastrointestinal tumours. 3,4 Moreover, octreotide, a somatostatin analogue, showed signifi cant effi cacy for the management of hepatocellular carcinoma in many studies and reviews. 5 Pistevou-Gombaki et al. 6,7 also reported a positive experience in liver metastases from non-neuroendocrine tumors with the use of octreotide LAR. A possible antitumor mechanism of octreotide is a stimulatory effect on Kupffer cells, induction of apoptosis or other antiproliferative actions, inhibition of proliferation, which have been suggested but not proved. 3,4 The aim of the present study is to evaluate the role, if any, of octreotide in palliative treatment of end-stage, inoperable, cholangiocarcinomas (Klatskin III and IV tumors), taking into account the abovementioned positive experience in relation to the absence of clear data and effi cacy of any available treatments in end-stage cholangiocarcinomas. We report on two male patients (A, B) 63-and 81-years-old, with obstructive icterus, due to advanced cholangiocarcinoma stage Klatskin III and IV respectively and liver metastases in patient A, who were palliatively treated by long acting octreotide IM (octreotide LAR) monthly, according to schema published previously, 7 in combination with successful endoscopic bile duct drainage. In both patients Klatskin tumor was demonstrated, in fi rst instance by abdominal echosonography and computed-tomography (CT), and thereafter by magnetic resonance imaging (MRI) and magnetic retrograde cholangiopancreatography (MRCP). Operation was excluded either due to advanced disease in patient A (liver metastases) and due to advanced age in patient B (81 years-old). Liver transplantation was also excluded due to advanced age and disease. Clinical examination revealed severe liver mass in both patients. Laboratory examination showed high bilirubin levels up to 30 mg/dl direct 20 mg/dl indirect 10 mg/dl, increased γ-GT, SGPT, ALF and highly increased tumor markers (CEA Ͼ1000 and CA19-9 Ͼ1000 mg/dl) in both patients. CRP was also elevated in both patients without however any other signs of overt cholangitis. In MRCP gallbladder was excluded in both patients due to infi ltration of cystic duct by the tumor. According to clinicolaboratoty results of these cases, the patients were urgently treated ...
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