Summary of Treatment Options
for Carcinoid Syndrome
The following are treatment options for the different symptoms
of carcinoid syndrome.
| Treatment Options for Carcinoid Syndrome | ||||
|---|---|---|---|---|
| Surgical debulking | Debulking of tumors may provide symptomatic relief by decreasing the amount of hormones secreted by tumor cells1,2. | |||
| 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 symptoms2,3. | |||
| Interferon–α | Works at the site of tumors to control severe diarrhea and flushing by regulating the immune system. | |||
| Somatostatin analogues such as Sandostatin® LAR Depot | Works at the site of the tumor to control hypersecretion. Sandostatin® LAR Depot (octreotide acetate for injectable suspension) suppresses 5-HIAA levels up to 50%, reduces frequency of severe diarrhea by up to 42%, and flushing episodes by up to 84%4,5,6. | |||
| Serotonin receptor blockers | Drugs that work peripherally to block the effects of increased peptides 1. | |||
| Antidiarrheal agents | Over-the-counter medicines that work at a peripheral level to control severe diarrhea7,8. | |||
Limitations of Antidiarrheal Agents in the Treatment of Severe Diarrhea Associated With Carcinoid Syndrome
Oral antidiarrheal therapies7,8:
- Work at a peripheral level away from the site of carcinoid tumors
- Provide no reduction in bioactive secretions
- Only treat severe diarrhea. Does not treat flushing.
The Rationale for Alternate Therapy
The clinical rationale for early intervention is to prevent the development of debilitating symptoms.
Excessive bioactive secretions lead to debilitating symptoms9:
- A patient's symptom profile can include a coexistence of major symptoms including severe diarrhea and flushing9
- Hypersecretion of bioactive substances and excessive fluid loss may lead to gastrointestinal morbidities10,11,12
Biochemical testing, early symptom recognition, and early treatment intervention are critical:
- 5-HIAA can be used to estimate the extent of carcinoid disease11,12
- Signs and symptoms of carcinoid syndrome are indicative of metastatic disease and a need for therapy that controls symptoms, as well as bioactive secretions13
INDICATIONS AND USAGE
Sandostatin® LAR Depot (octreotide acetate for injectable suspension) is indicated for patients in whom initial treatment with immediate release Sandostatin® (octreotide acetate) Injection has been shown to be effective and tolerated for:
- Long-term maintenance therapy in acromegalic patients who have had 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).
- Long-term treatment of the severe diarrhea and flushing episodes associated with metastatic carcinoid tumors.
- Long-term treatment of the profuse watery diarrhea associated with VIP-secreting tumors.
In patients with carcinoid syndrome and VIPomas, the effect of Sandostatin Injection and Sandostatin LAR Depot on tumor size, rate of growth and development of metastases has not been determined.
IMPORTANT SAFETY INFORMATION
Warnings and Precautions:
- Gallbladder abnormalities may occur: Patients should be monitored periodically.
- Glucose Metabolism: Hypoglycemia or hyperglycemia may occur. Blood glucose levels should be monitored when Sandostatin LAR Depot treatment is initiated or when the dose is altered. Antidiabetic treatment should be adjusted accordingly.
- Thyroid Function: Hypothyroidism may occur. Baseline and periodic assessment of thyroid function (TSH, total and/or free T4) is recommended.
- Cardiac Function: Bradycardia, arrhythmia, conduction abnormalities, and other EKG changes may occur. The relationship of these events to octreotide acetate is not established because many of these patients have underlying cardiac disease. Use with caution in at-risk patients.
- Nutrition: Octreotide may alter absorption of dietary fats. Monitoring of vitamin B12 levels is recommended during therapy with Sandostatin LAR Depot. Patients on total parenteral nutrition (TPN) and octreotide should have periodic monitoring of zinc levels.
Drug Interactions: The following drugs require monitoring and possible dose adjustment when used with Sandostatin LAR Depot: cyclosporine, insulin, oral hypoglycemic agents, beta-blockers, bromocriptine. Octreotide has been associated with alterations in nutrient absorption, so it may have an effect on absorption of orally administered drugs. Drugs mainly metabolized by CYP3A4 and which have a low therapeutic index should be used with caution.
Adverse Reactions: The most common adverse reactions occurring in patients receiving Sandostatin LAR Depot are:
- Acromegaly: biliary abnormalities (52%), diarrhea (36-48%), cholelithiasis (13-38%), abdominal pain or discomfort (11-29%), flatulence (26%), influenza-like symptoms (20%), constipation (19%), headache (15%), anemia (15%), hyperglycemia (15%), injection site pain (2-14%), hypertension (13%), dizziness (12%), fatigue (11%), nausea (10%), vomiting (7%), hypothyroidism (2%), hypoglycemia (2%), and goiter (2%).
- Carcinoid Tumors and VIPomas: biliary abnormalities (62%), injection site pain (20-50%), nausea (24-41%), abdominal pain (10-35%), fatigue (8-32%), headache (16-30%), hyperglycemia (27%), back pain (8-27%), constipation or vomiting (15-21%), dizziness (18-20%), sinus bradycardia (19%), pruritus (18%), URTI (10-18%), myalgia (4-18%), flatulence (9-16%), arthropathy (8-15%), rash (15%), generalized pain (4-15%), sinusitis (5-12%), conduction abnormalities (9%), hypoglycemia (4%), and arrhythmia (3%).
