Development and Clinical Uses of Octreotide Octreotide is a synthetic octapeptide SSA with more prolonged pharmacological actions than the endogenous hormone. Clinical Data Demonstrating the Antiproliferative Effect of Octreotide There is a long history of evidence for the antiproliferative effects of octreotide. Mean duration of response was Safety and Tolerability of Octreotide The safety profile of octreotide is well established, and both the short-and long-acting formulations are well tolerated in clinical practice and have been associated in improvements in quality of life.
Funding Statement Support: The publication of this article was supported by Novartis. References 1. Oberg K, Castellano D. Current knowledge on diagnosis and staging of neuroendocrine tumors. Cancer Metastasis Rev. Clinical pathology of endocrine tumors of the pancreas. Analysis of autopsy cases. Dig Dis Sci. J Clin Oncol. Gastroenteropancreatic neuroendocrine tumours.
Lancet Oncol. Lal A, Chen H. Treatment of advanced carcinoid tumors. Curr Opin Oncol. SMS a very potent and selective octapeptide analogue of somatostatin with prolonged action. Life Sci. Florio T. Molecular mechanisms of the antiproliferative activity of somatostatin receptors SSTRs in neuroendocrine tumors. Front Biosci. Susini C, Buscail L. Rationale for the use of somatostatin analogs as antitumor agents. Ann Oncol. High-dose octreotide acetate for management of gastroenteropancreatic neuroendocrine tumors.
Anticancer Res. Octreotide, a somatostatin analogue, mediates its antiproliferative action in pituitary tumor cells by altering phosphatidylinositol 3-kinase signaling and inducing Zac1 expression. Cancer Res. Somatostatin analogues in the control of neuroendocrine tumours: efficacy and mechanisms. Endocr Relat Cancer. Summary of product characteristics. Novartis pharmaceuticals. ENETS Consensus Guidelines for the management of patients with liver and other distant metastases from neuroendocrine neoplasms of foregut, midgut, hindgut, and unknown primary.
Placebo-controlled, double-blind, prospective, randomized study on the effect of octreotide LAR in the control of tumor growth in patients with metastatic neuroendocrine midgut tumors: a report from the PROMID Study Group. Therapeutic options for gastrointestinal carcinoids.
Clin Gastroenterol Hepatol. Consensus report on the use of somatostatin analogs for the management of neuroendocrine tumors of the gastroenteropancreatic system. Treatment of gastroenteropancreatic neuroendocrine tumours with octreotide LAR. Aliment Pharmacol Ther. Octreotide treatment of carcinoid hypertensive crisis. Mt Sinai J Med. Somatostatin receptor imaging: predictive and prognostic considerations. Long-acting octreotide and prolonged-release lanreotide formulations have different pharmacokinetic profiles.
J Clin Pharmacol. Pharmacokinetics, pharmacodynamics, and safety of microencapsulated octreotide acetate in healthy subjects. Malignant carcinoid syndrome: Survival in the octreotide LAR era. The symptoms of early dumping probably result from rapid emptying of hyperosmolar chyme into the small bowel leading to a large fluid shift from the intravascular space into the intestinal lumen, with consequent rapid small bowel distension and an increase in both the amplitude and frequency of bowel contractions.
Late dumping is a consequence of reactive hypoglycaemia resulting from an exaggerated insulin and glucagon-like peptide-1 release. The management of the dumping syndrome can be achieved in most cases by dietary modification and adjustment of lifestyle, in particular reduction of carbohydrate intake.
This results in marked weight loss, fear of eating and outdoor activities, or even an inability to maintain full time employment. For the past decade it has been suggested that octreotide Sandostatin SMS —; Novartis Pharmaceuticals, East Hanover, NJ, USA , an analogue of somatostatin, can alleviate dumping by slowing gastric emptying, inhibiting insulin release, decreasing enteric peptide secretion, increasing intestinal absorption of water and sodium, slowing monosaccharide absorption, increasing gut transit time, and preventing haemodynamic changes.
In particular, octreotide has been demonstrated to be effective in patients refractory to standard therapy. We have performed a systematic search for published randomised controlled trials on the effectiveness of octreotide in alleviating the symptoms of the dumping syndrome. In addition, citations of relevant primary and review articles were examined. Seven randomised controlled trials excluding one probably duplicated 4 were identified.
The following evidence of the effectiveness of octreotide for ameliorating dumping symptoms after the provocative glucose challenge were extracted from the seven trials and are summarised in table 1. Compared with the control cases, octreotide pretreatment resulted in significant improvement in symptoms in nearly all patients.
Decreased gain in pulse rates and stabilised blood pressure were particularly recorded in four trials. A recent editorial in the British Journal of Surgery stressed the importance of systematic reviews in assessing the effectiveness of treatment.
Our identified studies, admittedly involving relatively small numbers of patients, have unanimously shown short term benefit as well as promising long term results, confirming octreotide as an effective treatment for dumping syndrome. Side effects of octreotide such as steatorrhoea or early morning diarrhoea associated with long term treatment were managed with pancreatic enzyme replacement or an extra dose of octreotide before bedtime.
Based on their results, Geer et al suggested that, instead of gastrin or motilin, peptides such as pancreatic polypeptide, neurotensin, and glucagon may play a part in the development of dumping symptoms. We recommend that octreotide should be given for patients with severe or refractory dumping syndromes.
You will be able to get a quick price and instant permission to reuse the content in many different ways. During admission, intravenous octreotide treatment was initiated and feeding was changed from breast milk to a medium-chain triglyceride-enriched formula. The patient was discharged with full bottle feeding achieved. However, patients should be carefully monitored for side-effects such as hyperglycemia, necrotizing enterocolitis, transient hypothyroidism, and ileus.
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