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Published on: April 17, 2019
Biotherapy of pancreatic neuroendocrine tumors using somatostatin analogs
Hisato Igarashi1,2, Masayuki Hijioka2, Lingaku Lee2
1Clinical Education Center, Kyushu University Hospital, Fukuoka, Japan.
Abstract:
Basically, pancreatic neuroendocrine tumor (PNET) should be treated surgically; however, in unresectable cases, a treatment that aims to improve the prognosis by inhibiting the growth of the tumor and control the clinical symptoms becomes necessary. In the case of functional tumors, the quality of life of patients is decreased by not only the symptoms with tumor invasion and/or metastasis but also by the symptoms of hormone excess. The efficacy of somatostatin analogs against the latter has been previously reported, and their sustained release formulations have been developed. Somatostatin analogs are recommended to treat the endocrine symptoms of functional PNET; however, in case they can cause hypoglycemia in patients with insulinoma. On the other hand, results from the PROMID study demonstrated a tumor-stabilizing effect when octreotide LAR (long acting repeatable) was used to treat patients with advanced midgut NET; however, there has been no consensus regarding its antitumor effect for PNET. Additionally, a recent result from the CLARINET study suggests that lanreotide autogel has an antitumor effect against nonfunctional NET including PNET. Further clinical study results are awaited.
Insights
Pancreatic neuroendocrine tumors (PNETs) require surgery, but unresectable cases need treatments to inhibit growth and manage symptoms. Somatostatin analogs help with hormonal symptoms but may cause hypoglycemia in insulinoma patients.
Area of Science:
- Endocrinology
- Oncology
- Gastroenterology
Background:
- Pancreatic neuroendocrine tumors (PNETs) often require surgical intervention.
- For unresectable PNETs, treatments focus on inhibiting tumor growth and managing clinical symptoms.
- Functional PNETs significantly impact patient quality of life due to hormone excess and tumor progression.
Purpose of the Study:
- To review the role of somatostatin analogs in managing functional PNETs.
- To discuss the antitumor effects of somatostatin analogs in PNET treatment.
- To evaluate the current evidence for octreotide LAR and lanreotide autogel in PNET management.
Main Methods:
- Review of existing clinical studies and trial results (PROMID, CLARINET).
- Analysis of somatostatin analog efficacy for endocrine symptom control.
- Assessment of antitumor effects of long-acting somatostatin analogs.
Main Results:
- Somatostatin analogs are effective for endocrine symptoms in functional PNETs, but can cause hypoglycemia in insulinoma.
- Octreotide LAR showed tumor-stabilizing effects in advanced midgut neuroendocrine tumors (NETs), but its effect on PNETs is debated.
- Lanreotide autogel demonstrated antitumor effects in nonfunctional NETs, including PNETs, according to recent studies.
Conclusions:
- Somatostatin analogs are recommended for endocrine symptom control in functional PNETs, with caution for insulinomas.
- Evidence suggests potential antitumor effects of certain somatostatin analogs (lanreotide autogel) in PNETs.
- Further clinical studies are needed to establish definitive antitumor efficacy for PNET treatment.
