From the Guidelines
Somatostatin analogs, such as octreotide and lanreotide, are highly effective in managing symptoms and controlling tumor growth in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs), with a significant improvement in quality of life and progression-free survival, as demonstrated in the most recent and highest quality study 1.
Benefits of Somatostatin
The benefits of somatostatin analogs include:
- Control of symptoms such as diarrhea, flushing, and wheezing in patients with carcinoid syndrome
- Reduction of hormone secretion and cell proliferation in GEP-NETs
- Improvement in quality of life and progression-free survival
- Low incidence of side effects, including fat malabsorption, gall stones, and headaches
Therapeutic Uses
Somatostatin analogs are used to treat a variety of conditions, including:
- GEP-NETs, such as carcinoid tumors and pancreatic neuroendocrine tumors
- Acromegaly, by suppressing growth hormone secretion
- Dumping syndrome, by reducing gastric emptying and intestinal secretion
- Secretory diarrhea, by inhibiting intestinal secretion
Dosage and Administration
The typical starting dose of octreotide is 50-100 mcg subcutaneously three times daily, with a maximum daily dose of 1500 mcg. Lanreotide is administered as a deep subcutaneous injection, with a typical dose of 90-120 mg every 4-6 weeks.
Recent Evidence
The most recent and highest quality study, published in 2020 1, demonstrated the efficacy of lanreotide in controlling tumor growth and improving progression-free survival in patients with GEP-NETs. The study showed that lanreotide significantly improved progression-free survival, with a median progression-free survival of more than 27 months, compared to 18 months in the placebo arm.
From the FDA Drug Label
Octreotide acetate injection exerts pharmacologic actions similar to the natural hormone, somatostatin. It is an even more potent inhibitor of growth hormone (GH), glucagon, and insulin than somatostatin Like somatostatin, it also suppresses luteinizing hormone (LH) response to gonadotropin releasing hormone (GnRH), decreases splanchnic blood flow, and inhibits release of serotonin, gastrin, vasoactive intestinal peptide (VIP), secretin, motilin, and pancreatic polypeptide
The benefits of somatostatin include:
- Inhibition of growth hormone (GH), glucagon, and insulin
- Suppression of luteinizing hormone (LH) response to gonadotropin releasing hormone (GnRH)
- Decrease in splanchnic blood flow
- Inhibition of release of serotonin, gastrin, vasoactive intestinal peptide (VIP), secretin, motilin, and pancreatic polypeptide 2 3
From the Research
Benefits of Somatostatin
The benefits of somatostatin can be seen in its various clinical applications, including:
- Inhibiting gastrointestinal exocrine and endocrine secretions, motility, and blood flow 4
- Treating gastroenteropancreatic tumours, gastrointestinal fistulae, variceal bleeding, and diarrhoea 4
- Controlling symptoms of patients with functional gastro-entero-pancreatic neuroendocrine tumors (GEP-NETs) 5
- Stabilizing tumor growth in patients with progressive disease 5
- Treating other endocrine diseases such as somatotropinomas, thyrotropinomas, and functioning and non-functioning GEP-NETs 6
- Treating non-endocrine tumors such as breast, colon, prostate, lung, and hepatocellular cancer 6
- Treating digestive diseases such as chronic refractory diarrhea, hepatorenal polycystosis, gastrointestinal hemorrhage, dumping syndrome, and intestinal fistula 6
Therapeutic Uses of Somatostatin Analogs
Somatostatin analogs, such as octreotide, lanreotide, and pasireotide, have been developed for the treatment of various diseases, including:
- Acromegaly 7, 8
- GEP-NETs 5, 7
- Somatotropinomas, thyrotropinomas, and functioning and non-functioning GEP-NETs 6
- Non-endocrine tumors such as breast, colon, prostate, lung, and hepatocellular cancer 6
- Digestive diseases such as chronic refractory diarrhea, hepatorenal polycystosis, gastrointestinal hemorrhage, dumping syndrome, and intestinal fistula 6
Mechanism of Action
Somatostatin analogs work by binding to somatostatin receptors, which are canonical G protein-coupled proteins that play a role in metabolism, growth, and pathological conditions such as hormone disorders, neurological diseases, and cancers 8. The binding of somatostatin analogs to these receptors inhibits the release of various hormones and growth factors, leading to the therapeutic effects seen in various diseases.