In this section, you'll find at-a-glance information on topics related to treatment for carcinoid syndrome, including:
- Summary of Treatment Options for Carcinoid Syndrome
- Limitations of 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 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 | Works at the site of tumors to control diarrhea and flushing by regulating the immune system2,4,5. | |||
| 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 diarrhea by up to 42%, and flushing episodes by up to 84%6,7,8. | |||
| Antidiarrheal agents | Over-the-counter medicines that work at a peripheral level to control diarrhea9,10. | |||
| Diuretics | Agents that treat heart disease by helping the body get rid of excess fluid1,11,12. | |||
| Selective bronchodilators | Drugs used to control wheezing by dilating the airways1,11,12. | |||
| Serotonin receptor blockers | Drugs that work peripherally to block the effects of increased peptides12. | |||
Limitations of Antidiarrheal Agents
Oral antidiarrheal therapies9,10:
- Work at a peripheral level away from the site of carcinoid tumors
- Provide no reduction in bioactive secretions
- Only treat diarrhea. Troublesome flushing is left untreated
The Rationale for Targeted Therapy
The clinical rationale for early intervention with targeted therapies is to prevent the development of debilitating symptoms.
Excessive bioactive secretions lead to debilitating symptoms13:
- A patient's symptom profile can include a coexistence of major symptoms including diarrhea and flushing13
- Hypersecretion of bioactive substances and excessive fluid loss may lead to gastrointestinal morbidities14,15,16
Biochemical testing, early symptom recognition, and early treatment intervention are critical:
- Monitoring CgA and 5-HIAA levels contribute to effective disease management17
- 5-HIAA can be used to estimate the extent of carcinoid disease15,16
- 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
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.
