Metastatic insulinoma-outcomes in the current era
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Updated: Jun 9, 2025
Robotic Enucleation of an Intra-Pancreatic Insulinoma in the Pancreatic Head
Published on: January 3, 2020
Umesh Masharani1, Sheila Lindsay2, Farhana Moon2
1Department of Medicine, University of California, San Francisco, CA 94143, United States.
Background:
Multimodal interventions in neuroendocrine tumors appear to have a beneficial impact on survival. Metastatic insulinoma is associated with hypoglycemia and, historically, a shortened life expectancy.
Methods:
The authors retrospectively analyzed the clinical outcomes of patients with metastatic insulinomas treated at a tertiary care center between 2006 and 2023.
Results:
Clinical data on 14 patients with metastatic insulinoma (metastases to the liver, skeleton, and lung) were reviewed in this descriptive study. The patients underwent various treatments including surgery; liver directed therapies (embolization, selective internal radiotherapy), somatostatin analogs; targeted agents (everolimus); systemic chemotherapy (capecitabine/temozolomide; carboplatin/etoposide); external beam radiation; and peptide receptor radiotherapy. Seven subjects died during follow-up. The time of the 7 deaths ranged from 2.5 to 10.4 years (median time to death was 8.2 years). This compares to previous reports of median survival of about 2 years. Seven subjects are alive 1.2-12.3 years after diagnosis. Hypoglycemia was well-controlled and did not cause the deaths.
Conclusions:
Multimodal interventions in metastatic insulinoma can be effective in managing hypoglycemia. The patients on multimodal treatments also lived a long time when considering previous published reports of median survival of just 2 years. Our findings challenge previous assumptions regarding clinical outcomes in this patient population.
Insights
Multimodal treatments for metastatic insulinoma effectively manage hypoglycemia and significantly extend survival, challenging previous assumptions about patient outcomes.
Area of Science:
- Oncology
- Endocrinology
- Medical Research
Background:
- Metastatic insulinoma historically presents with hypoglycemia and poor prognosis.
- Multimodal interventions show promise in neuroendocrine tumor management.
Purpose of the Study:
- To evaluate the effectiveness of multimodal interventions in metastatic insulinoma.
- To assess the impact on survival and hypoglycemia control.
Main Methods:
- Retrospective analysis of 14 metastatic insulinoma patients (2006-2023).
- Review of diverse treatments: surgery, liver-directed therapies, somatostatin analogs, targeted agents, chemotherapy, and radiation.
Main Results:
- Median survival was 8.2 years, significantly longer than the historical 2 years.
- Seven patients are alive between 1.2-12.3 years post-diagnosis.
- Hypoglycemia was effectively managed and did not cause mortality.
Conclusions:
- Multimodal interventions improve outcomes for metastatic insulinoma.
- These treatments offer extended survival and effective hypoglycemia management.
- Findings challenge prior expectations of clinical outcomes in this patient group.
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