Octreotide and Lanreotide in Gastroenteropancreatic Neuroendocrine Tumors

Pokuri, Venkata; Fong, Mei Ka; Iyer, Renuka

doi:10.1007/s11912-015-0492-7

Cited by 38 publications

(38 citation statements)

References 55 publications

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“…Treatment with octreotide LAR, in which only 6.3% of patients had a primary tumor site of the pancreas, was associated with more gastroenterologist visits and lower use of imaging procedures. The difference may be explained by the fact that the PROMID trial was limited to midgut NETs, and there are no RCTs that have assessed antitumor benefit of octreotide LAR among patients with pancreatic NETs . Differences in carcinoid syndrome prevalence across the two SSAs studied also suggest that clinicians use the two SSAs differently and are again consistent with the FDA‐approved indications contemporary to the study period.…”

Section: Discussionmentioning

confidence: 97%

“…Dose escalations and dosing deviations were both more common among octreotide LAR patients compared with lanreotide depot patients, likely the result of evidence suggesting that the dose of an SSA beyond label and guideline recommendations can lead to improved control of refractory symptoms associated with carcinoid syndrome arising from midgut primary tumors However, reasons for dose escalation (and reasons for the use of short‐acting octreotide) were not directly captured in this claims‐based analyses. Although the use of octreotide LAR at doses greater than 30 mg per 4 weeks for symptom control in NETs is supported by National Comprehensive Cancer Network recommendations , the use of higher doses of octreotide LAR is associated with increased costs and patient administration burden. Recent analyses have assessed the added cost of treating patients at higher doses of octreotide LAR compared with treating patients at the recommended dose of lanreotide depot ; the authors estimated additional annual costs of approximately $5,000 and $40,000 per patient if treatment of octreotide LAR was dosed at 40 mg per 4 weeks or 60 mg per 4 weeks, respectively, compared with 120 mg per 4 weeks of lanreotide depot in one single injection.…”

Section: Discussionmentioning

confidence: 99%

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Patterns of Care Among Real-World Patients with Metastatic Neuroendocrine Tumors

Klink

Feinberg

et al. 2019

The Oncologist

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Background Although recent pivotal trials (PROMID, CLARINET) have established somatostatin analogs (SSAs) as first‐line agents for neuroendocrine tumors (NETs), their use in clinical practice is largely unknown. We aimed to understand real‐world management and treatment of gastroenteropancreatic (GEP) NETs. Materials and Methods Patients with metastatic GEP‐NETs treated with SSAs, lanreotide depot or octreotide long‐acting release (LAR), between January 1, 2015, and December 31, 2015, were identified from a U.S. claims database supplemented with chart review for a subset of patients. Descriptive statistics summarized patients’ demographics, clinical characteristics, treatment patterns, and healthcare resource use. Univariate and multivariate comparisons were made across SSA groups. Results Among 548 patients treated with an SSA for metastatic GEP‐NET (lanreotide = 108; octreotide = 440), demographic and clinical characteristics were similar across groups, except more patients with pancreatic NETs were treated with lanreotide (38.7% vs. 6.3%, p < .01). More octreotide patients had a diagnosis of carcinoid syndrome compared with lanreotide patients (19.8% vs. 11.1%, p = .02). Approximately 1.1% of patients received lanreotide (>120 mg every 4 weeks [Q4W]) at a dose above label compared with 12.7% of octreotide patients (>30 mg Q4W; p < .01). At 1.5 years after SSA initiation, 85.7% (95% confidence interval, 74.3%–92.3%) were still on index SSA as reported by the physician. Variances between chart review and claims data were significant. Conclusion SSAs were common in first‐line systemic intervention, but dose escalations and dosing deviations outside of label were noted. Variances between claims and chart review warrant additional research to compare methodologies. With an increasing focus on value‐based care in oncology, it is critical to understand the use of, and outcomes with, these agents in community practices. Implications for Practice The aim of this study was to enhance understanding of real‐world management and treatment of metastatic neuroendocrine tumors (NETs), with particular focus on systemic therapy with a somatostatin analog (SSA). As per published guidelines, SSAs are common in first‐line systemic intervention, but dose escalations and dosing deviations outside of the label are noted for symptom control. Nevertheless, oncologists must weigh the implications of the use of above‐label dosing of SSAs to manage and treat patients with metastatic NET within a value‐based care framework.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Patterns of Care Among Real-World Patients with Metastatic Neuroendocrine Tumors

Klink

Feinberg

et al. 2019

The Oncologist

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“…Long acting somatostatin analogues(Octreotide-LAR, Lanreotide-autogel) supplemented during break-through with subcutaneous octreotide, are the standard therapies for controlling the principal carcinoid syndrome symptoms of diarrhea, flushing, and asthma[2, •96, 98, •120, 145, •146]. With time, refractory cases may develop and therefore, there is a need for new treatments[2, •96, 98, •120, 145, •146].…”

Section: Summary Of Recent Advances In Management Of Specific Hormmentioning

confidence: 99%

“…With time, refractory cases may develop and therefore, there is a need for new treatments[2, •96, 98, •120, 145, •146]. Treatment of the carcinoid heart disease involves standard treatment for heart failure/arrhymias and in advanced cases, heart valve replacement[147].…”

Section: Summary Of Recent Advances In Management Of Specific Hormmentioning

confidence: 99%

Treatment of symptomatic neuroendocrine tumor syndromes: recent advances and controversies

Ito¹,

Lee²,

Jensen³

2016

Expert Opinion on Pharmacotherapy

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Introduction Neuroendocrine tumors(NETs), once thought rare, are increasing in frequency in most countries and receiving increasing-attention. NETs present two-treatment problems. A proportion is functional, hormone-excess-state(F-NET), each of which must be treated. Recently, there are many advances, well-covered in reviews/consensus papers on imaging-NETs;new, novel anti-tumor treatments and understanding their pathogenesis. However, little attention has been paid to advances in the treatment of the hormone-excess-state. These advances are usually reported in case-series, and case-reports with few large studies. In this paper these advances are reviewed. Areas covered Advances in the last 5-years are concentrated on, but a review up to 10-years was performed. PubMed and other databases(Cochrane, etc) were searched for F-NET-syndromes including carcinoid-syndrome, as well as meeting-abstracts on NETs. All advances that controlled hormone-excess-states or facilitated-control were covered. These include new medical-therapies[serotonin-synthesis inhibitors(telotristat), Pasireotide, new agents for treating ACTHomas], increased dosing with conventional therapies(octreotide-LAR, Lanreotide-Autogel), mTor inhibitors(everolimus), Tyrosine-kinase inhibitors(sunitinib), cytoreductive surgery, liver-directed therapies(embolization, chemoembolization, radioembolization, RFA), peptide radio-receptor-therapy(PRRT) and 131I-MIBG, ablation of primary F-NETs. Expert Opinion Although many of the newer therapies controlling the hormone-excess-states in F-NETs are reported in relatively few patients, all the approaches show promise. Their description also generates some controversies/unresolved areas, such as the order of these new treatments, their longterm-efficacy, and effectiveness of combinations which may require large, controlled studies.

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“…This is best achieved with somatostatin analogs (e.g. : octreotide or lanreotide) by reducing the secretion of vasoactive mediators (10,12,15,26,27,28). Histamine-induced flushing may be treated with H1 and H2 receptor blockers (10).…”

Section: Neuroendocrine Causes Of Flushingmentioning

confidence: 99%

Flushing in (neuro)endocrinology

Hannah‐Shmouni

Stratakis

Koch

2016

Rev Endocr Metab Disord

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Cutaneous flushing is a common presenting complaint in endocrine disorders. The pathophysiology of flushing involves changes in cutaneous blood flow triggered by multiple intrinsic factors that are either related to physiology or disease. Flushing can be divided into episodic or persistent causes. Episodic flushing is mediated by the release of endogenous vasoactive mediators or medications, while persistent flushing results in a fixed facial erythema with telangiectasia and a cyanotic tinge owing to the large cutaneous blood vessels that contain slow-flowing deoxygenated blood. The differential diagnosis of cutaneous flushing in neuroendocrine disorders is limited, yet encompasses a broad spectrum of benign and malignant entities, including carcinoid syndrome, pheochromocytoma, Cushing syndrome, medullary thyroid cancer, and pancreatic neuroendocrine tumors. In this review, we provide a concise and up-to-date discussion on the differential diagnosis and approach of flushing in neuroendocrinology.

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Octreotide and Lanreotide in Gastroenteropancreatic Neuroendocrine Tumors

Cited by 38 publications

References 55 publications

Patterns of Care Among Real-World Patients with Metastatic Neuroendocrine Tumors

Patterns of Care Among Real-World Patients with Metastatic Neuroendocrine Tumors

Treatment of symptomatic neuroendocrine tumor syndromes: recent advances and controversies

Flushing in (neuro)endocrinology

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