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Objective radiological disease control with sandostatin monotherapy in metastatic neuroendocrine tumours
M Khasraw1, A Townsend, T Price
1Department of Medical Oncology, Royal North Shore Hospital, Sydney, New South Wales 2065, Australia. mkhasraw@med.usyd.edu.au
Abstract:
Conventional cytotoxic chemotherapy is not usually effective in neuroendocrine tumours (NET). Somatostatin analogues (SSA) such as octreotide (Sandostatin; octreotide LAR and lanreotide) are typically used to treat symptoms caused by NET, but not as the primary treatment aiming for an objective response. Recently, results from the PROMID (Placebo-controlled prospective Randomized study on the antiproliferative efficacy of Octreotide LAR in patients with metastatic neuroendocrine MIDgut tumours) trial were published showing that octreotide LAR significantly lengthens the time to tumour progression compared with a placebo in patients with functionally active and inactive metastatic midgut NET. We report a retrospective descriptive analysis of six patients, treated at two Australian institutions, who obtained an objective radiological tumour response on long acting SSA. In this retrospective series of NET, radiological responses were observed using single agent SSA, which was administered mainly for symptom management. This could be due to an antiproliferative and/or antiangiogenic activity of this agent in NET. A response can occur beyond 12 months, which might explain why the response rate is under reported in NET trials. Further investigation in prospective trials is warranted and the possibility for late responses might have implications for trial design.
Insights
Long-acting somatostatin analogues (SSA) demonstrated objective radiological tumor responses in neuroendocrine tumors (NET), challenging their role solely for symptom management. These responses, potentially linked to antiproliferative effects, may occur late, impacting trial design.
Area of Science:
- Oncology
- Endocrinology
- Radiology
Background:
- Conventional chemotherapy shows limited efficacy in neuroendocrine tumors (NET).
- Somatostatin analogues (SSA) are primarily used for symptom management in NET, not for achieving objective tumor responses.
- Recent PROMID trial data suggest SSA can prolong tumor progression time in metastatic midgut NET.
Observation:
- A retrospective analysis of six NET patients treated with long-acting SSA revealed objective radiological tumor responses.
- SSA was administered primarily for symptom control in these patients.
- Observed responses suggest potential antiproliferative or antiangiogenic activity of SSA in NET.
Findings:
- Single-agent SSA achieved objective radiological responses in a small cohort of NET patients.
- These responses indicate a potential direct anti-tumor effect of SSA beyond symptom palliation.
- Tumor responses to SSA can manifest later than 12 months, potentially explaining underreporting in trials.
Implications:
- SSA may have a direct antiproliferative role in NET, warranting further investigation.
- The potential for late responses has significant implications for the design of future NET clinical trials.
- Re-evaluating the role of SSA as a primary treatment in specific NET contexts is suggested.
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