The heterogeneous groups of neoplasms that originate from the diffuse endocrine system are referred to as the superclass of neuroendocrine tumors (NETs)1.
The most common type of NETs are gastroenteropancreatic neuroendocrine tumors (GEP NETs), which occur in the digestive tract, primarily in the gut (stomach or intestine) or the pancreas. NETs produce and secrete excessive amounts of hormones and other substances that are normally regulated in the body in smaller amounts. The excessive secretion of these hormones leads to a constellation of debilitating symptoms2-5.
GEP NETs are further differentiated based on histology, where well-differentiated GEP NETs are classified as classic carcinoid tumors that are either functioning or nonfunctioning. GEP NETS are considered functioning if they are associated with a clinical syndrome related to the release of highly bioactive substances, and nonfunctioning if they are not associated with such symptoms2-5.
In well-differentiated, functioning carcinoid tumors, the clinical symptoms of metastatic spread—referred to as carcinoid syndrome or carcinoid disease—are associated with significant morbidity and mortality, but are still so vague that misdiagnosis as more common disorders still occurs frequently2-5.
VIPomas (vasoactive intestinal peptide tumors) are rare cancers in which tumor cells arise from certain hormone-producing cells called islet cells. These islet cells are most often located in the pancreas, an organ that produces insulin and hormones that aid in digestion. However, these cells may also be located in or around the adrenal glands, which are hormone-secreting glands that are located just above each kidney. In some cases, these VIPomas continue to produce excessive amounts of hormones, particularly one called vasoactive intestinal peptide, which plays a role in water transport in the intestines. The excessive amount of this hormone causes the symptoms of the disease, of which watery diarrhea is the most prominent1,6.
Treatment options typically evolve along 3 paths6:
- Surgery to remove or debulk the tumor
- Targeted therapies and procedures that reduce or remove the tumor and/or reduce hypersecretion at the site of the tumor
- Peripheral therapies that can temporarily relieve the symptoms of carcinoid syndrome
Most prominent symptoms7,8:
- Diarrhea and flushing
- Fluid loss from diarrhea may lead to serious health consequences
Other possible symptoms:
- Abdominal pain
- Cardiac lesions
- Wheezing
Important Safety Information
Carcinoid Syndrome:
Sandostatin® LAR Depot (octreotide acetate for injectable suspension) is indicated for long-term treatment of the severe diarrhea and flushing episodes associated with metastatic carcinoid tumors and for the long-term treatment of the profuse watery diarrhea associated with VIP-secreting tumors in patients in whom initial treatment with immediate release Sandostatin® (octreotide acetate) Injection has been shown to be effective and tolerated.
Important Safety Information:
As with immediate release Sandostatin® Injection, the most frequently reported drug-related adverse events were biliary disorders (62%), gastrointestinal disorders (14% to 38%), and injection-site pain (20% to 50%). Hypoglycemia (4%), hyperglycemia (27%), sinus bradycardia (19%), conduction abnormalities (9%), and arrhythmias (3%) have been reported.
The controlled clinical trials that support the marketing clearance for Sandostatin® LAR Depot did not include determination of effect on tumor size or rate of growth. Sandostatin® LAR Depot is not indicated for tumor shrinkage.
Acromegaly
Sandostatin® LAR Depot (octreotide acetate for injectable suspension) is indicated for long-term maintenance therapy in acromegalic patients who have had an inadequate response to surgery and/or radiotherapy, or for whom surgery and/or radiotherapy is not an option. The goal of treatment in acromegaly is to reduce GH and IGF-1 levels to normal.
Important Safety Information:
As with immediate release Sandostatin® Injection, the most frequently reported drug-related adverse events were biliary disorders (52%), gastrointestinal disorders (7% to 36%), and injection-site pain (2% to 11%). Hypoglycemia (2%), hyperglycemia (15%), and hypothyroidism (2%) have been reported. While not measured in acromegalic patients receiving Sandostatin® LAR Depot, ECG changes have been reported in patients receiving immediate release Sandostatin® Injection; the degree to which these abnormalities are related to octreotide acetate is not clear, as many acromegalics have cardiovascular disease. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
