Tumor control is a recommended treatment goal
Guidelines recommend surgery as the primary treatment for tumors. For localized tumors, surgery is potentially curative, giving 5-year survival rates of 80% to 100%.1
However, the majority of patients with neuroendocrine tumors (NET) have metastatic disease at diagnosis.2 For these patients, surgery may not be curative.2 In metastatic disease, the role of surgery is to reduce tumor mass. If residual tumor is present after surgery, medical treatment may be considered.3
Hepatic embolization may also be used to control metastases that have spread to the liver. It works by decreasing blood supply to the liver and starving tumor cells.4
When curative surgery is not an option, guidelines recommend antiproliferative therapy with somatostatin analogs.
Routinely monitor for progression4
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| Treat with antiproliferative therapy5 "As most patients with NET are diagnosed once metastases have occurred, [patients] require chronic postoperative medical management with the aim of […] suppressing tumor growth and spread" – Oberg KE. Clin Oncol. 2012.
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Sandostatin® LAR®—the most prescribed somatostatin analog in the world6*
Sandostatin® LAR® is a somatostatin analog approved to treat advanced NET of the midgut or of unknown primary origin where non-midgut sites of origin have been excluded.7†
In PROMID, a Phase III, randomized, double-blind, placebo-controlled trial of a range of treatment-naïve patients with advanced midgut gastrointestinal NET, 42 patients were treated with Sandostatin® LAR® and 43 patients received placebo.7
- Time to progression: 14.3 months with 30 mg of Sandostatin® LAR® every 4 weeks vs 6.0 months with placebo (P=0.000072)7
- 30 mg of Sandostatin® LAR® reduced the risk of disease progression by 66% (HR=0.34; 95% Cl: 0.20-0.59)7
Sandostatin® LAR®, at different dosages, is also proven to provide long-term symptom control of functional gastrointestinal and pancreatic NET, such as VIPomas, glucagonomas, gastrinomas, and insulinomas. Sandostatin® LAR® has been shown to reduce 5-HIAA levels by 50% (38%-50%), flushing by 84%, and severe diarrhea by 42%.8,9
Other therapeutic options: Chemotherapy, radiation, and interferon therapy
Somatostatin analogs like Sandostatin® LAR® are not the only available treatment options for advanced midgut NET. Other therapeutic options may include chemotherapy, radiation, and interferon therapy.
Although chemotherapy is standard for endocrine pancreatic tumors, it has only a modest effect on low-proliferating gastrointestinal and pancreatic NET. Its use therefore depends on the type of tumor and its level of differentiation.10
For patients with tumors that express a high number of somatostatin receptors determined by Octreoscan™, tumor-targeted radiation therapy may be an option.10
In patients with functioning tumors, interferon therapy has also shown efficacy in controlling symptoms of carcinoid syndrome related to hormone release.10
*Includes Sandostatin® Immediate-release Injection and Sandostatin® LAR Depot for all approved indications.
†The recommended dose of Sandostatin® LAR® for tumor control in advanced midgut NET is 30 mg administered every 4 weeks. Treatment with Sandostatin® LAR® for tumor control should be continued in the absence of tumor progression.11
Octreoscan is a trademark of Curium.
References:
1. Oberg K, Jelic S; on behalf of the ESMO Guidelines Working Group. Neuroendocrine gastroenteropancreatic tumors: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol. 2008;19(suppl 2):ii104-ii105. 2. Yao JC, Hassan M, Phan A, et al. One hundred years after "carcinoid": epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol. 2008;26:3063-3072. 3. Modlin IM, Kidd M, Latich I, Zikusoka MN, Shapiro MD. Current status of gastrointestinal carcinoids. Gastroenterology. 2005;128:1717-1751. 4. Howell DL, O'Dorisio MS. Management of neuroendocrine tumors in children, adolescents, and young adults. J Pediatr Hematol Oncol. 2012;34:S64-S68. 5. Oberg KE. The management of neuroendocrine tumours: current and future medical therapy options. Clin Oncol. 2012;24:282-293. 6. IMS Report to Novartis Pharmaceuticals Corp; 2012. 7. Rinke A, Muller H-H, Schade-Brittinger C, et al. Placebo-controlled, double-blind, prospective, randomized study on the effect of octreotide LAR in the control of tumor growth in patients with metastatic neuroendocrine midgut tumors: a report from the PROMID Study Group. J Clin Oncol. 2009;27:4656-4663. 8. Sandostatin LAR Depot [prescribing information]. East Hanover, NJ: Novartis Pharmaceuticals Corp; 2019. 9. Rubin J, Ajani J, Schirmer W, et al. Octreotide acetate long-acting formulation versus open-label subcutaneous octreotide acetate in malignant carcinoid syndrome. J Clin Oncol. 1999;17:600-606. 10. Plockinger U, Rindi G, Arnold R, et al. Guidelines for the diagnosis and treatment of neuroendocrine gastrointestinal tumours: a consensus statement on behalf of the European Neuroendocrine Tumour Society (ENETS). Neuroendocrinology. 2004;80:394-424. 11. Sandostatin® LAR® Summary of Product Characteristics. Novartis Pharma AG. 2018.