Treatment Summary
On this page:
- Summary of Treatment Options for Carcinoid Syndrome
- Comparing Sandostatin LAR® Depot to Antidiarrheal Agents
- The Rationale for Targeted Therapy
Summary of Treatment Options for Carcinoid Syndrome
The following are treatment options for the different symptoms of carcinoid syndrome.
Treatment Options for Carcinoid Syndrome
| Targeted Therapies | |
|---|---|
| Surgical debulking | Debulking of tumors may provide symptomatic relief by decreasing the amount of hormones secreted by tumor cells |
| Chemoembolization | Injection of a chemotherapeutic drug with a blocking agent into the main blood vessel of the liver to treat tumors that have spread to the liver and control symptoms |
| Interferon | Works at the site of tumors to control diarrhea and flushing by regulating the immune system |
| Somatostatin analogue | Works at the site of the tumor to control hypersecretion and reduce diarrhea and flushing. Sandostatin LAR® Depot (octreotide acetate for injectable suspension) is a somatostatin analogue. |
| Targeted Therapies | |
| Antidiarrheal agents | Over-the-counter medicines that work at a peripheral level to control diarrhea |
| Diuretics | Agents that treat heart disease by helping the body get rid of excess fluid |
| Selective bronchodilators | Drugs used to control wheezing by dilating the airways |
| Serotonin receptor blockers | Drugs that work peripherally to block the effects of increased peptides |
Comparing Sandostatin LAR® Depot to Antidiarrheal Agents
Oral antidiarrheal therapies:
- Work at a peripheral level away from the site of carcinoid tumors (1, 2).
- Provide no reduction in bioactive secretions.
- Only treat diarrhea. Troublesome flushing is left untreated (1, 2).
The Rationale for Targeted Therapy
The clinical rationale for early intervention with targeted therapies is to prevent the development of debilitating symptoms (3).
CARCINOID TUMOR METASTASIZES TO THE LIVER (3)
TUMOR GIVES OFF HARMFUL BIOACTIVE SECRETIONS
CARCINOID SYNDROME DEVELOPS
DEBILITATING SYMPTOMS DEVELOP
Excessive bioactive secretions lead to debilitating symptoms (4, 5)
- A patient's symptom profile can include a coexistence of major symptoms including diarrhea and flushing (5, 6)
- Hypersecretion of bioactive substances and excessive fluid loss may lead to gastrointestinal morbidities (4, 7, 8)
Biochemical testing, early symptom recognition, and early treatment intervention are critical
- Monitoring CgA and 5-HIAA levels contribute to effective disease management (9)
- 5-HIAA can be used to estimate the extent of carcinoid disease (4, 7)
- Signs and symptoms of carcinoid syndrome are indicative of metastatic disease and a need for targeted therapy that controls symptoms, as well as bioactive secretions
References
- Imodium® A-D (loperamide hydrochloride) Prescribing Information. 2000-2004, Fort Washington, PA: McNeil Consumer Products Company.
- Lomotil® (diphenoxylate hydrochloride with atropine sulfate) Prescribing Information. 2001, Chicago, IL: Pharmacia & Upjohn Company.
- Kulke MH, Mayer RJ, Carcinoid tumors. N Engl J Med. 1999;340(11):858-68.
- Jensen RT, Doherty GM, Carcinoid tumors and the carcinoid syndrome, in Cancer: Principles & Practice of Oncology, V.T. De Vita, S. Hellman, and S.A. Rosenburg, Editors. 2001, Lippincott Williams & Wilkins: Philadelphia, PA. p. 1813-1833.
- Vinik AI, Thompson N, Eckhauser F, et al, Clinical features of carcinoid syndrome and the use of somatostatin analogue in its management. Acta Oncol. 1989;28(3):389-402.
- Creutzfeldt W, Carcinoid tumors: development of our knowledge. World J Surg. 1996;20(2):126-31.
- McCormick D, Carcinoid tumors and syndrome. Gastroenterol Nurs. 2002;25(3):105-11.
- Davis Z, Moertel CG, McIlrath DC, The malignant carcinoid syndrome. Surg Gynecol Obstet. 1973;137(4):637-44.
- Oberg K, Kvols L, Caplin M, et al, Consensus report on the use of somatostatin analogs for the management of neuroendocrine tumors of the gastroenteropancreatic system. Ann Oncol. 2004;15(6):966-73.
