The Treatment of Neuroendocrine Tumors (NET) with Somatostatin Analogs

PURPOSE To understand the quality of life (QoL) for patients with neuroendocrine tumors (NETs) through comparison of QoL questionnaires and symptom tracking as well as journaling via the Carcinoid NETs Health Storylines mobile application (app). PATIENTS AND METHODS This was a 12-week prospective, observational study of US patients with NET who were taking long-acting somatostatin analogs. National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) and European Organisation for Research and Treatment of Cancer (EORTC) questionnaires were administered three times. Patients also monitored symptoms, mood, bowel movements, food, activity, and sleep, and they journaled in their app, which was coded by theme and sentiment for qualitative analysis. RESULTS Of the 120 patients with NET, 78% were women (mean age, 57 years); 76% had gastroenteropancreatic NETs, and 88% had metastases. Lanreotide depot and octreotide long-acting release (LAR) were used by 41% and 59%, respectively. The most common symptoms at baseline were fatigue (76.7%), diarrhea (62.5%), abdominal discomfort (64.1%), and trouble sleeping (57.5%). The majority completed five of six survey assessments (median, 5; mean, 5.1) and tracked four symptoms in the app (median, 4; mean, 5.5); the average frequency was 41.6 days for each symptom (median, 43; mean, 41.6; range, 1 to 84 days [12 weeks]). Without treatment change, most EORTC-assessed physical symptoms decreased from baseline to midpoint (eg, 59.3% at baseline v 33% at midpoint reported “quite a bit” or “very much” diarrhea; P = .002). App-based symptom tracking revealed large day-to-day variation, but weekly averages correlated well with survey scores. Journal entries showed that more patients made predominantly negative unsolicited entries about their injection experience with octreotide LAR compared with lanreotide (13 of 17 v two of 13; P < .001). CONCLUSION Patients with NET experience a large symptom burden that varies daily. A decrease in physical symptoms on QoL surveys suggests an effect from daily app-based monitoring or journaling, which may reduce recall bias and benefit the patient’s experience of symptoms.

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Efficacy of Somatostatin Analogs (Ssa) in Gastroenteropancreatic Neuroendocrine Tumors (Gep-Net) According to Ki67 Index: a Single Centre Experience

Annals of Oncology ◽

10.1093/annonc/mdu345.14 ◽

2014 ◽

Vol 25 ◽

pp. iv399

Author(s):

R. Marconcini ◽

S. Ricci ◽

E. Vasile ◽

L. Galli ◽

A. Antonuzzo ◽

...

Keyword(s):

Neuroendocrine Tumors ◽

Somatostatin Analogs ◽

Ki67 Index ◽

Single Centre ◽

Gastroenteropancreatic Neuroendocrine Tumors ◽

Single Centre Experience

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Biliary Stone Disease in Patients with Neuroendocrine Tumors Treated with Somatostatin Analogs: A Multicenter Study

The Oncologist ◽

10.1634/theoncologist.2019-0403 ◽

2019 ◽

Vol 25 (3) ◽

pp. 259-265 ◽

Cited By ~ 1

Author(s):

Nicole Brighi ◽

Francesco Panzuto ◽

Roberta Modica ◽

Fabio Gelsomino ◽

Manuela Albertelli ◽

...

Keyword(s):

Neuroendocrine Tumors ◽

Multicenter Study ◽

Somatostatin Analogs ◽

Stone Disease ◽

Biliary Stone

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Nutritional Complications and the Management of Patients with Gastroenteropancreatic Neuroendocrine Tumors

Neuroendocrinology ◽

10.1159/000503634 ◽

2019 ◽

Vol 110 (5) ◽

pp. 430-442 ◽

Cited By ~ 4

Author(s):

Erin Laing ◽

Nicole Kiss ◽

Michael Michael ◽

Meinir Krishnasamy

Keyword(s):

Clinical Practice ◽

Neuroendocrine Tumors ◽

Dietary Habits ◽

Somatostatin Analogs ◽

The United States ◽

The Body ◽

Care Needs ◽

Gastroenteropancreatic Neuroendocrine Tumors ◽

Vitamin Deficiencies ◽

The Impact

Neuroendocrine tumors (NETs) have increased in incidence and prevalence over the past 2 decades and affect approximately 170,000 people in the United States alone. Gastroenteropancreatic (GEP) NETs (GEP NET) are a heterogeneous group of rare tumors that have distinct effects on the body due to their tumor location and potential to secrete hormones and peptides. Clinical practice guidelines and consensus guidelines for GEP NETs with regard to best practice for diagnosis, treatment, and medical management are available, but the supportive care needs and optimal nutritional management of patients affected by these unique tumors remain under-researched: evidence to guide clinical practice is lacking. The pathophysiology of the disease and its treatment can cause various symptoms that can have significant effects on vitamin synthesis and absorption, dietary habits, weight change, and appetite. Deficiency of fat-soluble vitamins and niacin exists amongst patients with GEP NET, particularly those on treatment with somatostatin analogs and with serotonin-secreting tumors, respectively. Malnutrition and dietary modification amongst patients with GEP NET is more prevalent than initially thought: up to 25% of inpatients with GEP NET are malnourished. Food intolerance is also reported in up to 40–90% of these patients, though its misdiagnosis is common. This review summarizes the evidence regarding the impact of GEP NET and its treatment on nutritional factors in these patients with emphasis on malnutrition, vitamin deficiencies, dietary intake, and quality of life. Recommendations for clinical practice and research approaches to address these nutritional issues are discussed.

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Prediction of Progression-Free Survival in Patients With Advanced, Well-Differentiated, Neuroendocrine Tumors Being Treated With a Somatostatin Analog: The GETNE-TRASGU Study

Journal of Clinical Oncology ◽

10.1200/jco.19.00980 ◽

2019 ◽

Vol 37 (28) ◽

pp. 2571-2580 ◽

Cited By ~ 8

Author(s):

Alberto Carmona-Bayonas ◽

Paula Jiménez-Fonseca ◽

Ángela Lamarca ◽

Jorge Barriuso ◽

Ángel Castaño ◽

...

Keyword(s):

Neuroendocrine Tumors ◽

Failure Time ◽

Somatostatin Analogs ◽

Progression Free Survival ◽

Accelerated Failure Time Model ◽

Endocrine Tumors ◽

First Line ◽

Ki 67 ◽

Free Survival ◽

Well Differentiated

PURPOSE Somatostatin analogs (SSAs) are recommended for the first-line treatment of most patients with well-differentiated, gastroenteropancreatic (GEP) neuroendocrine tumors; however, benefit from treatment is heterogeneous. The aim of the current study was to develop and validate a progression-free survival (PFS) prediction model in SSA-treated patients. PATIENTS AND METHODS We extracted data from the Spanish Group of Neuroendocrine and Endocrine Tumors Registry (R-GETNE). Patient eligibility criteria included GEP primary, Ki-67 of 20% or less, and first-line SSA monotherapy for advanced disease. An accelerated failure time model was developed to predict PFS, which was represented as a nomogram and an online calculator. The nomogram was externally validated in an independent series of consecutive eligible patients (The Christie NHS Foundation Trust, Manchester, United Kingdom). RESULTS We recruited 535 patients (R-GETNE, n = 438; Manchester, n = 97). Median PFS and overall survival in the derivation cohort were 28.7 (95% CI, 23.8 to 31.1) and 85.9 months (95% CI, 71.5 to 96.7 months), respectively. Nine covariates significantly associated with PFS were primary tumor location, Ki-67 percentage, neutrophil-to-lymphocyte ratio, alkaline phosphatase, extent of liver involvement, presence of bone and peritoneal metastases, documented progression status, and the presence of symptoms when initiating SSA. The GETNE-TRASGU (Treated With Analog of Somatostatin in Gastroenteropancreatic and Unknown Primary NETs) model demonstrated suitable calibration, as well as fair discrimination ability with a C-index value of 0.714 (95% CI, 0.680 to 0.747) and 0.732 (95% CI, 0.658 to 0.806) in the derivation and validation series, respectively. CONCLUSION The GETNE-TRASGU evidence-based prognostic tool stratifies patients with GEP neuroendocrine tumors receiving SSA treatment according to their estimated PFS. This nomogram may be useful when stratifying patients with neuroendocrine tumors in future trials. Furthermore, it could be a valuable tool for making treatment decisions in daily clinical practice.

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Response and relapse rates after treatment with long-acting somatostatin analogs in multifocal or recurrent type-1 gastric carcinoids: A systematic review and meta-analysis

United European Gastroenterology Journal ◽

10.1177/2050640619890465 ◽

2019 ◽

Vol 8 (2) ◽

pp. 140-147 ◽

Cited By ~ 1

Author(s):

Roberta Elisa Rossi ◽

Pietro Invernizzi ◽

Vincenzo Mazzaferro ◽

Sara Massironi

Keyword(s):

Systematic Review ◽

Neuroendocrine Tumors ◽

Response Rate ◽

Complete Response Rate ◽

Somatostatin Analogs ◽

Complete Response ◽

Long Acting ◽

Cumulative Relapse Rate

Background Type-1 gastric neuroendocrine tumors represent a recurring disease and long-acting somatostatin analogs can inhibit both gastrin release and endocrine cell proliferation. The efficacy and timing of this treatment are still unclear. We performed a systematic review of the literature to clarify the role of somatostatin analog treatment in type-1 gastric neuroendocrine tumors. Methods A computerized literature search was performed using relevant keywords to identify all the pertinent articles published in the last 15 years. Results Eight studies were included in this systematic review on somatostatin analogs in type-1 gastric neuroendocrine tumors. A complete response rate ranged from 25–100%. When only the six prospective studies were considered, no significant heterogeneity was observed, and the pooled cumulative complete response rate was 84.5% (confidence interval 73.8–92.8). Three studies evaluated the type-1 gastric neuroendocrine tumor recurrence, with a cumulative relapse rate of 30.2% (confidence interval 13.1–50.6) after 34 months. Conclusion Somatostatin analogs, namely lanreotide and octreotide, have an excellent response rate, with a good safety profile in selected type-1 gastric neuroendocrine tumors, which cannot be safely managed by endoscopic follow-up or resection due to multiple or frequently recurring disease. After therapy discontinuation, the cumulative relapse rate observed after a median 34-month follow-up was relatively high (30.2%).

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