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Opportunities to Improve Symptom Control with Somatostatin Congeners in GEP-NETs: A Review of Key Issues. | LitMetric

Opportunities to Improve Symptom Control with Somatostatin Congeners in GEP-NETs: A Review of Key Issues.

Oncologist

Department of Internal Medicine, Division of Endocrinology and Metabolism, Holden Cancer Center, University of Iowa, Iowa City, Iowa, USA.

Published: July 2021

AI Article Synopsis

  • Octreotide acetate is a widely used and studied treatment for gastroenteropancreatic neuroendocrine tumors and carcinoid syndrome, with two available formulations: immediate-release (IR) and long-acting repeatable (LAR).
  • Despite the popularity of octreotide LAR, it faces challenges such as loss of bioactivity over time, leading some patients to require supplemental IR octreotide for symptom control.
  • The review emphasizes the need to reassess the role of IR octreotide alongside depot therapy to enhance symptom management and discusses its relevance during the COVID-19 pandemic.

Article Abstract

Octreotide acetate (octreotide) is the most prescribed and most studied somatostatin congener, or analog, for gastroenteropancreatic neuroendocrine tumors (GEP-NETs) and carcinoid syndrome, the latter of which may be characterized by debilitating diarrhea and flushing. Approved in the U.S. more than 30 years ago, octreotide is widely used to control the symptoms of carcinoid syndrome and has been shown to demonstrate antiproliferative activity. The two formulations available in the U.S. include a subcutaneous immediate-release (IR) injection introduced in 1989 and a long-acting repeatable (LAR) intramuscular injection approved in 1999. Lanreotide depot (lanreotide), a more recent somatostatin congener, has been available in the U.S. since 2014. Despite widespread use of octreotide LAR, several key challenges exist with the current depot-based treatment paradigm. Studies indicate that LAR formulations are associated with continued unmet patient needs, owing in part to a loss of bioactivity over time that may necessitate progressive supplemental treatment with IR octreotide to adequately control symptoms. Clinicians should understand the key differences in the pharmacokinetic profiles of the LAR and IR formulations that may contribute to bioactivity loss and somatostatin receptor desensitization. In addition, there is a need to re-evaluate the role of IR octreotide in combination with depot therapy to provide consistent bioavailability and better control of carcinoid syndrome symptoms. The purpose of this review is to explore all these issues and to re-establish a rationale for the IR formulation, particularly with respect to novel use cases and its use during the COVID-19 pandemic. IMPLICATIONS FOR PRACTICE: There is a need to re-evaluate the role of immediate-release octreotide in combination with depot therapy to provide consistent bioavailability and better control of carcinoid syndrome symptoms.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8265352PMC
http://dx.doi.org/10.1002/onco.13847DOI Listing

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