What are the treatment options for metastatic carcinoid tumor of the lung?

From the Guidelines

Treatment of metastatic carcinoid tumor of the lung should prioritize a multi-modal approach, with somatostatin analogs (SSAs) as the mainstay of treatment for unresectable disease, and targeted therapies such as everolimus or peptide receptor radionuclide therapy (PRRT) for progressive disease, as recommended by the most recent guidelines 1. The treatment options for metastatic carcinoid tumor of the lung are based on the extent of disease and patient factors.

• First-line treatment typically involves surgical resection of the primary tumor and isolated metastases when feasible.
• For unresectable disease, somatostatin analogs like octreotide LAR or lanreotide are the mainstay of treatment, as they control symptoms and may slow tumor growth by binding to somatostatin receptors on tumor cells.
• For progressive disease, targeted therapies such as everolimus (10 mg orally daily) or peptide receptor radionuclide therapy (PRRT) with lutetium-177 dotatate have shown efficacy, as supported by recent guidelines 1.
• Liver-directed therapies including embolization, chemoembolization, or radioembolization may be used for predominant liver metastases.
• Chemotherapy with temozolomide or capecitabine plus temozolomide is generally reserved for aggressive, rapidly progressive disease.
• Symptom management is crucial and may include telotristat ethyl for carcinoid syndrome diarrhea. Treatment selection should be individualized based on tumor characteristics, functional status, and symptom burden, with a multidisciplinary approach involving pulmonologists, oncologists, surgeons, and interventional radiologists, as emphasized in recent studies 1. Key considerations in treatment selection include:
• Tumor type (typical or atypical carcinoid)
• Disease extent and progression
• Symptom burden and quality of life
• Patient preferences and performance status The most recent and highest quality study, published in 2021, provides guidance on the treatment of metastatic lung or thymic carcinoids, including the use of SSAs, everolimus, and PRRT 1. Additionally, another study published in 2021, also provides recommendations for the treatment of advanced carcinoids, including the use of SSAs, everolimus, and chemotherapy 1. Overall, the treatment of metastatic carcinoid tumor of the lung requires a comprehensive and individualized approach, taking into account the latest evidence and guidelines 1.

From the FDA Drug Label

Octreotide acetate injection is indicated for the symptomatic treatment of patients with metastatic carcinoid tumors where it suppresses or inhibits the severe diarrhea and flushing episodes associated with the disease. Carcinoid Tumors: For the symptomatic treatment of patients with metastatic carcinoid tumors where it suppresses or inhibits the severe diarrhea and flushing episodes associated with the disease.

The treatment options for metastatic carcinoid tumor of the lung include symptomatic treatment with:

• Octreotide acetate injection (IM) 2 to suppress or inhibit severe diarrhea and flushing episodes associated with the disease
• Octreotide acetate injection is also available, with the same indications 3 Note: These treatments do not show an effect on the size, rate of growth, or development of metastases.

From the Research

Treatment Options for Metastatic Carcinoid Tumor of the Lung

• The treatment of metastatic carcinoid tumor of the lung involves a multidisciplinary approach, including medical treatments such as somatostatin analog (SSA) therapy, targeted therapy, chemotherapy, or peptide receptor radionuclide therapy 4.
• Somatostatin analogs, such as octreotide and lanreotide, are cornerstones in the symptomatic management of patients suffering from carcinoid tumors and have also been reported to have antiproliferative activity 5, 6.
• Octreotide and lanreotide are the two somatostatin analogs currently available in clinical practice, and they have been approved for controlling the clinical syndrome associated with functioning neuroendocrine tumors (NET) and for tumor growth control in advanced low/intermediate grade NET 6.
• A case study reported that a patient with a disseminated carcinoid tumor progressed during treatment with lanreotide but developed a pronounced response after treatment was switched to octreotide, suggesting that refractoriness to treatment with one somatostatin analog does not automatically imply resistance to a related agent 5.
• The optimal dosage of somatostatin analogs for the long-term control of carcinoid tumors has not yet been established, but a single daily dose of octreotide based on tumor marker levels may be effective in avoiding the phenomenon of somatostatin receptor desensitization 7.
• Other treatment options for metastatic carcinoid tumor of the lung include chemotherapy with a cisplatin-based or streptozotocin-based combination, palliation with biotherapy including interferon, somatostatin analogs, and octreotide, and liver embolization for symptomatic liver involvement 8.
• Surgical management remains the mainstay of therapy for localized carcinoid tumors, and a multimodal radiological work-up is used for diagnosis, with contrast-enhanced CT and functional imaging techniques 4, 8.