From the Guidelines
Peptide infusion, specifically somatostatin analogues, is the recommended treatment for symptomatic patients with gastroenteropancreatic neuroendocrine tumours, as it has been shown to improve quality of life and inhibit hormone production in 30-70% of patients. The use of somatostatin analogues, such as octreotide, lanreotide, and Sandostatin LAR, has been proven to be effective in managing symptoms and improving quality of life in patients with these tumours 1. These analogues work by binding to receptor subtypes 2 and 5, inhibiting the release of various peptide hormones, and antagonizing growth factor effects on tumour cells.
Key Points to Consider
- Somatostatin analogues are the only proven hormonal management of neuroendocrine tumours (NETs) 1
- Octreotide has a half-life of several hours, making intermittent therapy possible, and is typically administered by subcutaneous injection starting at 50-100 mg twice or three times a day 1
- Long-acting somatostatin analogues, such as lanreotide and Sandostatin LAR, have shown significant improvement in quality of life and have as good or better efficacy compared to short-acting octreotide 1
- Patients may experience side effects, including fat malabsorption, gall stones, and vitamin A and D malabsorption, and should be monitored regularly for circulating and urinary hormone levels, as well as relevant imaging 1
Administration and Monitoring
- Somatostatin analogues should be administered by a healthcare professional, with proper sterile technique and monitoring of patients for potential side effects 1
- Patients should be stabilized with short-acting octreotide for 10-28 days before converting to long-acting somatostatin analogues 1
- Escalation of dose is often needed over time, and patients should be monitored regularly for efficacy and safety throughout treatment 1
From the Research
Peptide Infusion
- Peptide infusion, specifically growth hormone-releasing peptides (GHRPs), has been studied for its effects on growth hormone (GH) secretion and insulin-like growth factor I (IGF-I) levels 2, 3, 4, 5.
- GHRPs, such as GHRP-2, have been shown to stimulate GH secretion in a dose-dependent manner, with effects comparable to those of GH-releasing hormone (GHRH) 2, 3.
- The mechanism of action of GHRPs is thought to involve specific receptors at the pituitary and hypothalamic levels, although the exact mechanisms are still unclear 2, 3.
- Studies have demonstrated the efficacy of GHRP-2 in stimulating GH secretion and increasing IGF-I levels in various populations, including healthy older adults and patients with protracted critical illness 4, 5.
Clinical Applications
- GHRPs have potential clinical applications in the treatment of GH hyposecretory states, such as idiopathic GH deficiency and obesity 2, 3.
- Peptide infusion may also be useful in the management of protracted critical illness, where it has been shown to reactivate blunted GH and TSH secretion and induce a shift toward anabolic metabolism 4.
- The use of GHRPs in cosmeceuticals and pharmaceuticals is also being explored, with potential applications in the treatment of various diseases and conditions 6.
Administration and Dosage
- GHRPs can be administered via various routes, including intravenous, subcutaneous, intranasal, and oral 2, 3.
- The optimal dosage and duration of GHRP-2 infusion have been studied, with sustained elevation of pulsatile GH secretion and IGF-I levels observed during 30-day continuous subcutaneous infusion in older men and women 5.