No Follow-Up Paper from BSG by Mudan on Octreotide Dosing for Small Bowel NET Surgery
Based on the available evidence, there is no follow-up paper from the British Society of Gastroenterology (BSG) by an author named Mudan regarding octreotide dosing for small bowel neuroendocrine tumor surgery.
Current Octreotide Dosing Guidelines for NETs
The National Comprehensive Cancer Network (NCCN) guidelines provide the most comprehensive recommendations for octreotide dosing in neuroendocrine tumors 1:
- For patients with carcinoid syndrome: Standard doses of octreotide LAR are 20-30 mg intramuscularly every 4 weeks
- Dose and frequency may be increased for symptom control as needed
- Short-acting octreotide (150-250 mcg subcutaneously 3 times daily) can be added for breakthrough symptoms
For perioperative management, particularly during surgery for NETs:
- For patients undergoing surgery with risk of carcinoid crisis, high-dose octreotide is recommended
- A prophylactic approach includes 500-μg bolus intravenously followed by continuous infusion of 500 μg/hour 2
FDA-Approved Dosing Information
The FDA label for octreotide provides these specific dosing recommendations 3:
- For carcinoid tumors: Initial dosage during first 2 weeks ranges from 100-600 mcg/day in 2-4 divided doses
- Median maintenance dosage is approximately 450 mcg/day
- Clinical benefits may be obtained with doses as low as 50 mcg, while others require up to 1500 mcg/day
- Experience with doses above 750 mcg/day is limited
Small Bowel NETs: Current Management Approaches
Small bowel NETs are commonly managed with:
- Surgical resection (primary treatment even in metastatic disease) 4
- Somatostatin analogues (octreotide) as adjunctive therapy 4
- Advanced imaging techniques like DOTATATE scans for detection 4
For patients with progressive disease on somatostatin analogues, additional options include radionuclide therapy, targeted agents, and liver-directed therapy 5.
Mechanism of Action
Octreotide works through somatostatin receptors, but recent research has identified additional mechanisms through upregulation of six novel genes: ANXA1, ARHGAP18, EMP1, GDF15, TGFBR2, and TNFSF15 6. This may explain its efficacy even when somatostatin receptor levels are low.
Caution in Special Populations
Octreotide should be used with extreme caution in patients with insulinoma as it can worsen hypoglycemia 7.
While there is extensive literature on octreotide use in NETs, including small bowel NETs, the evidence does not include a specific follow-up paper from the BSG by an author named Mudan focusing on octreotide dosing for small bowel NET surgery.