From the Guidelines
The initial treatment for carcinoid syndrome is a somatostatin analogue, specifically octreotide or lanreotide, to control symptoms and tumor growth. According to the most recent and highest quality study 1, patients with metastatic NETs and carcinoid syndrome should be treated using a somatostatin analogue. The standard doses of octreotide LAR are 20 to 30 mg intramuscularly every 4 weeks, and short-acting octreotide (usually 150–250 mcg subcutaneously, 3 times daily) can be added for rapid relief of symptoms or for breakthrough symptoms.
Key Considerations
- The long-acting release (LAR) formulation of octreotide is commonly used for the chronic management of symptoms in patients with carcinoid syndrome 1.
- Lanreotide has a similar mechanism of action as octreotide and is administered as a deep subcutaneous injection, with studies showing it to be effective at controlling symptoms in patients with carcinoid tumors 1.
- For patients with poorly controlled diarrhea, telotristat should be considered, as it decreases urinary 5-HIAA levels and the frequency of bowel movements in patients with carcinoid syndrome 1.
Treatment Approach
- Somatostatin analogs are the mainstay of treatment, and addressing the underlying neuroendocrine tumor through surgery, liver-directed therapies, or systemic treatments is also essential for comprehensive management.
- Supportive treatments, such as loperamide for diarrhea and avoidance of triggers like alcohol and certain foods, can also be beneficial.
- The goal of treatment is to control the hallmark symptoms of carcinoid syndrome, including flushing, diarrhea, and wheezing, by blocking the release of serotonin and other vasoactive substances from carcinoid tumors.
From the FDA Drug Label
1 INDICATIONS AND USAGE
- 3 Carcinoid Syndrome SOMATULINE DEPOT is indicated for the treatment of adults with carcinoid syndrome; when used, it reduces the frequency of short-acting somatostatin analog rescue therapy.
The initial treatment for carcinoid syndrome is SOMATULINE DEPOT (lanreotide), which reduces the frequency of short-acting somatostatin analog rescue therapy 2.
- Key points:
- Indicated for the treatment of adults with carcinoid syndrome
- Reduces the frequency of short-acting somatostatin analog rescue therapy
- No information on the specific dosage or administration schedule for the initial treatment of carcinoid syndrome is provided in the given text.
From the Research
Initial Treatment for Carcinoid Syndrome
The initial treatment for carcinoid syndrome typically involves the use of somatostatin analogues, which have been shown to be effective in controlling symptoms such as flushing and diarrhea.
- Lanreotide and octreotide are two commonly used somatostatin analogues for the treatment of carcinoid syndrome 3, 4, 5, 6, 7.
- These medications can be administered via injection, with lanreotide typically given every 10-14 days and octreotide given twice or thrice daily 3, 4.
- The choice of medication and dosage may depend on individual patient factors, such as the severity of symptoms and patient preference 3, 6.
Efficacy of Somatostatin Analogues
Studies have demonstrated the efficacy of lanreotide and octreotide in reducing symptoms of carcinoid syndrome, including:
- Decreased frequency and intensity of flushing episodes 3, 4, 6
- Reduced number of bowel movements and improved diarrhea symptoms 3, 4, 6
- Decreased urinary 5-hydroxyindoleacetic acid (5-HIAA) levels, a marker of tumor activity 3, 5, 6
- Improved quality of life and patient satisfaction 3, 7
Dosage and Administration
The optimal dosage and administration schedule for lanreotide and octreotide may vary depending on the individual patient and the specific formulation used.
- Lanreotide can be administered at a dose of 30 mg intramuscularly every 10-14 days 3, 4, 7.
- Octreotide can be administered at a dose of 100-200 micrograms subcutaneously twice or thrice daily, with the option to titrate the dose as needed 5, 6.
- Long-acting formulations of octreotide, such as octreotide LAR, can be administered at a dose of 10-30 mg intramuscularly every 4 weeks 6.