Management of malignant insulinoma

Ferrer-García, Juan Carlos; González-Cruz, Vega Iranzo; Navas-DeSolís, S.; Civera-Andrés, Miguel; Morillas, Carlos; Merchante-Alfaro, Agustín Ángel; Caballero-Díaz, C.; Sánchez-Juan, Carlos; Camps, Carlos

doi:10.1007/s12094-012-0996-7

Cited by 30 publications

(27 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Conversely, patients with malignant unresectable insulinomas may take great advantage of this effect, as shown by some retrospective studies in this setting (Bernard et al 2013;Ferrer-Garcia et al 2013). Therefore, everolimus could be employed as first line treatment for progressive malignant insulinomas with refractory hypoglycaemia, as suggested by recent guidelines.…”

Section: Discussionmentioning

confidence: 99%

“…Overall, 8 retrospective studies were identified (Bernard et al 2013;Capdevila et al 2015;Ferrer-Garcia et al 2013;Fiebrich et al 2011;Kulke et al 2009;Liu et al 2016;Panzuto et al 2014;Tippeswamy et al 2015), which included a total of 183 patients with pancreatic and 135 patients with extra-pancreatic NETs (see Table 2a). …”

Section: Published Retrospective Studiesmentioning

confidence: 99%

See 1 more Smart Citation

Everolimus as first line therapy for pancreatic neuroendocrine tumours: current knowledge and future perspectives

Gallo

Malandrino

Fanciulli

et al. 2017

J Cancer Res Clin Oncol

View full text Add to dashboard Cite

Results We identified eight retrospective published studies, two prospective published studies, and five registered clinical trials. Moreover, we analyzed the content of four widespread international guidelines. Conclusions Our critical review confirms the lack of highquality data to recommend everolimus as the first line therapy for pNETs. The ongoing clinical trials reported in this review will hopefully help clinicians, in the near future, to better evaluate the role of everolimus as the first line therapy for pNETs. However, at the moment, there is already enough evidence to recommend everolimus as the first line therapy for patients with symptomatic malignant unresectable insulin-secreting pNETs, to control the endocrine syndrome regardless of tumour growth.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Published Retrospective Studiesmentioning

confidence: 99%

Everolimus as first line therapy for pancreatic neuroendocrine tumours: current knowledge and future perspectives

Gallo

Malandrino

Fanciulli

et al. 2017

J Cancer Res Clin Oncol

View full text Add to dashboard Cite

show abstract

“…Approximately 30-50% of patients respond to SSAs, although this treatment may be ineffective in the control of hypoglycaemia, and the condition of some patients may deteriorate during the therapy [200][201][202][203][204][205][206]. In certain cases hypoglycaemia may increase due to inhibited glucagon secretion [9,207].…”

Section: Szkolenie Podyplomowementioning

confidence: 99%

Nowotwory neuroendokrynne trzustki — zasady diagnostyki i leczenia (rekomendowane przez Polską Sieć Guzów Neuroendokrynych)

Kos–Kudła¹,

Rosiek²,

Borowska³

et al. 2017

Endokrynologia Polska

View full text Add to dashboard Cite

“…32 The somatostatin analog mechanism of decreasing or arresting NETs growth has been attributed to the inhibition of cell proliferation of normal and tumor cells via induction of G 1 cell cycle arrest and apoptosis. 30,33 Although the success of these somatostatin analogs were mostly for small-bowel NETs and some pancreatic neuroendocrine tumors (PNETs), their antiproliferative-specific effects on insulinomas alone are yet to be defined. With regards to malignant insulinoma, establishing the presence of SSTR2 receptors in the primary tumor and in metastases may be valuable in avoiding severe hypoglycemia in patients without this receptor.…”

Section: Medical Management Of Insulinomamentioning

confidence: 99%

“…With regards to malignant insulinoma, establishing the presence of SSTR2 receptors in the primary tumor and in metastases may be valuable in avoiding severe hypoglycemia in patients without this receptor. 33 Limited studies with variable outcomes have identified other SSTR subtypes involved in cell proliferation in malignant insulinomas, such as SSTR5 messenger (m)RNA expression, which could potentially be targeted for therapeutic options. 33 Other agents that have been used for the medical treatment of insulinoma with various degrees of outcomes include phenytoin, verapamil, propranolol, glucocorticoids, and lastly glucagon.…”

Section: Medical Management Of Insulinomamentioning

confidence: 99%

Diagnosis and management of insulinoma: current best practice and ongoing developments

Taye¹,

Libutti²

2015

RRED

View full text Add to dashboard Cite

Insulinoma is a predominantly benign and rare neuroendocrine tumor. Patients with insulinoma typically present with neurologic symptoms from hypoglycemia, such as confusion, dizziness, and behavioral changes, as well as symptoms from a surge in catecholamine levels, such as palpitations, diaphoresis, and tachycardia. Symptomatic patients usually have glucose levels below 55 mg/dL and are relieved of their symptoms when carbohydrate is administered. The 48-hour test, performed by measuring blood glucose levels of insulin, C peptide, and proinsulin collected every 4-6 hours in fasting patients, accurately confirms the diagnosis of insulinoma in the majority of the patients. Once the diagnosis is confirmed, the next step in management involves identifying the location of the tumor and successfully removing it surgically. In the last two decades, clinicians have moved away from invasive angiography for preoperative localization. A multiphase computed tomography (CT) can be used to localize the lesion and evaluate for metastasis. If CT does not detect the lesion, selective arterial calcium stimulation test is recommended to identify the region of the lesion in the pancreas. Some argue that all preoperative localization techniques are superfluous. The combination of intraoperative ultrasound and operative palpation has led to a nearly 100% success rate. Recently, in select cases, laparoscopic enucleations and resections of insulinomas have been performed with shorter length of stay and faster recovery time. Despite advances in imaging, a little over 10% of insulinoma patients undergo reexploration for missing lesions. Patients who are not candidates for tumor resections or awaiting surgery have had symptomatic relief from diazoxide and somatostatin analogs among various medical therapies. In patients with metastatic insulinoma, progressionfree survival and overall survival are reported from newly approved chemotherapeutic agents. Liver-directed therapies, such as ablation and selective radiation, and cytoreductive surgery have also been performed for symptom control and prolonging survival.

show abstract

Management of malignant insulinoma

Abstract: Hypoglycemia management is complex and requires multiple therapies. Further evaluations will be necessary to determine the best treatment.

Cited by 30 publications

References 20 publications

Everolimus as first line therapy for pancreatic neuroendocrine tumours: current knowledge and future perspectives

Everolimus as first line therapy for pancreatic neuroendocrine tumours: current knowledge and future perspectives

Nowotwory neuroendokrynne trzustki — zasady diagnostyki i leczenia (rekomendowane przez Polską Sieć Guzów Neuroendokrynych)

Diagnosis and management of insulinoma: current best practice and ongoing developments

Contact Info

Product

Resources

About