This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Rubin, J. Articles by Anthony, L. Search for Related Content PubMed PubMed Citation Articles by Rubin, J. Articles by Anthony, L.

Octreotide Acetate Long-Acting Formulation Versus Open-Label Subcutaneous Octreotide Acetate in Malignant Carcinoid Syndrome

From the Mayo Clinic, Rochester, MN; M.D. Anderson Cancer Center, Houston, TX; the Ohio State University Hospital, Columbus, OH; University of California at San Francisco, San Francisco, CA; The Cleveland Clinic Foundation, Cleveland, OH; Oregon Health Sciences University, Portland, OR; Memorial Sloan-Kettering Hospital, New York, NY; the State University of New York, Buffalo, NY; and Louisiana State University Medical Center, New Orleans, LA.

Address reprint requests to Joseph Rubin, MD, Mayo Clinic, Division of Medical Oncology, 200 First St, SW, Rochester, MN 55905.

PURPOSE: Subcutaneous (SC) octreotide acetate effectively relieves the diarrhea and flushing associated with carcinoid syndrome but requires long-term multiple injections daily. A microencapsulated long-acting formulation (LAR) of octreotide acetate has been developed for once-monthly intramuscular dosing.

PATIENTS AND METHODS: A randomized trial compared double-blinded octreotide LAR at 10, 20, and 30 mg every 4 weeks with open-label SC octreotide every 8 hours for the treatment of carcinoid syndrome. Seventy-nine patients controlled with treatment of SC octreotide 0.3 to 0.9 mg/d whose symptoms returned during a washout period and who returned for at least the week 20 evaluation constituted the efficacy-assessable population.

RESULTS: Complete or partial treatment success was comparable in each of the four arms of the study (SC, 58.3%; 10 mg, 66.7%; 20 mg, 71.4%; 30 mg, 61.9%; P .72 for all pairwise comparisons). Control of stool frequency was similar in all treatment groups. Flushing episodes were best controlled in the 20-mg LAR and SC groups; the 10-mg LAR treatment was least effective in the control of flushing. Treatment was well tolerated by patients in all four groups.

CONCLUSION: Once octreotide steady-state concentrations are achieved, octreotide LAR controls the symptoms of carcinoid syndrome at least as well as SC octreotide. A starting dose of 20 mg of octreotide LAR is recommended. Supplemental SC octreotide is needed for approximately 2 weeks after initiation of octreotide LAR treatment. Occasional rescue SC injections may be required for possibly 2 to 3 months until steady-state octreotide levels from the LAR formulation are achieved.

This article has been cited by other articles:

				L. K. Kvols Revisiting C.G. Moertel's Land of Small Tumors J. Clin. Oncol., November 1, 2008; 26(31): 5005 - 5007. [Full Text] [PDF]

				S. Grozinsky-Glasberg, I. Shimon, M. Korbonits, and A. B Grossman Somatostatin analogues in the control of neuroendocrine tumours: efficacy and mechanisms Endocr. Relat. Cancer, September 1, 2008; 15(3): 701 - 720. [Abstract] [Full Text] [PDF]

				A. J. Espay REVERSIBLE PARKINSONISM AND ATAXIA ASSOCIATED WITH HIGH-DOSE OCTREOTIDE Neurology, June 10, 2008; 70(24): 2345 - 2346. [Full Text] [PDF]

				M. Debono, L.-Q. Hon, N. Bax, A. Blakeborough, and J. Newell-Price Gluteal Nodules in Patients with Metastatic Midgut Carcinoid Disease Treated with Depot Somatostatin Analogs J. Clin. Endocrinol. Metab., May 1, 2008; 93(5): 1860 - 1864. [Abstract] [Full Text] [PDF]

				A. Moreno, A. Akcakanat, M. F Munsell, A. Soni, J. C Yao, and F. Meric-Bernstam Antitumor activity of rapamycin and octreotide as single agents or in combination in neuroendocrine tumors Endocr. Relat. Cancer, March 1, 2008; 15(1): 257 - 266. [Abstract] [Full Text] [PDF]

				M. H Kulke Gastrointestinal neuroendocrine tumors: a role for targeted therapies? Endocr. Relat. Cancer, June 1, 2007; 14(2): 207 - 219. [Abstract] [Full Text] [PDF]

				N Fazio, F de Braud, G Delle Fave, and K Oberg Interferon-{alpha} and somatostatin analog in patients with gastroenteropancreatic neuroendocrine carcinoma: single agent or combination? Ann. Onc., January 1, 2007; 18(1): 13 - 19. [Abstract] [Full Text] [PDF]

				M. H. Shah, P. Binkley, K. Chan, J. Xiao, D. Arbogast, M. Collamore, Y. Farra, D. Young, and M. Grever Cardiotoxicity of Histone Deacetylase Inhibitor Depsipeptide in Patients with Metastatic Neuroendocrine Tumors. Clin. Cancer Res., July 1, 2006; 12(13): 3997 - 4003. [Abstract] [Full Text] [PDF]

				S. H. Gunn, J. E. Schwimer, M. Cox, C. T. Anthony, M. S. O'Dorisio, and E. A. Woltering In Vitro Modeling of the Clinical Interactions Between Octreotide and 111In-Pentetreotide: Is There Evidence of Somatostatin Receptor Downregulation? J. Nucl. Med., February 1, 2006; 47(2): 354 - 359. [Abstract] [Full Text] [PDF]

				J. E. Moller, P. A. Pellikka, A. M. Bernheim, H. V. Schaff, J. Rubin, and H. M. Connolly Prognosis of Carcinoid Heart Disease: Analysis of 200 Cases Over Two Decades Circulation, November 22, 2005; 112(21): 3320 - 3327. [Abstract] [Full Text] [PDF]

				E. Bajetta, L. Catena, G. Procopio, E. Bichisao, L. Ferrari, S. Della Torre, S. De Dosso, S. Iacobelli, R. Buzzoni, L. Mariani, et al. Is the new WHO classification of neuroendocrine tumours useful for selecting an appropriate treatment? Ann. Onc., August 1, 2005; 16(8): 1374 - 1380. [Abstract] [Full Text] [PDF]

				B. Astruc, P. Marbach, H. Bouterfa, C. Denot, M. Safari, A. Vitaliti, and M. Sheppard Long-Acting Octreotide and Prolonged-Release Lanreotide Formulations Have Different Pharmacokinetic Profiles J. Clin. Pharmacol., July 1, 2005; 45(7): 836 - 844. [Abstract] [Full Text] [PDF]

				J K Ramage, A H G Davies, J Ardill, N Bax, M Caplin, A Grossman, R Hawkins, A M McNicol, N Reed, R Sutton, et al. Guidelines for the management of gastroenteropancreatic neuroendocrine (including carcinoid) tumours Gut, June 1, 2005; 54(suppl_4): iv1 - iv16. [Full Text] [PDF]

				A. B. Benson III, J. A. Ajani, R. B. Catalano, C. Engelking, S. M. Kornblau, J. A. Martenson Jr, R. McCallum, E. P. Mitchell, T. M. O'Dorisio, E. E. Vokes, et al. Recommended Guidelines for the Treatment of Cancer Treatment-Induced Diarrhea J. Clin. Oncol., July 15, 2004; 22(14): 2918 - 2926. [Abstract] [Full Text] [PDF]

				G. A. Kaltsas, G. M. Besser, and A. B. Grossman The Diagnosis and Medical Management of Advanced Neuroendocrine Tumors Endocr. Rev., June 1, 2004; 25(3): 458 - 511. [Abstract] [Full Text] [PDF]

				J. E. Moller, H. M. Connolly, J. Rubin, J. B. Seward, K. Modesto, and P. A. Pellikka Factors Associated with Progression of Carcinoid Heart Disease N. Engl. J. Med., March 13, 2003; 348(11): 1005 - 1015. [Abstract] [Full Text] [PDF]

				P. J. Gilbar The role of octreotide in symptom management in oncology and palliative care Journal of Oncology Pharmacy Practice, September 1, 2000; 6(3): 81 - 91. [Abstract] [PDF]

				P. Tomassetti, M. Migliori, G. C. Caletti, P. Fusaroli, R. Corinaldesi, and L. Gullo Treatment of Type II Gastric Carcinoid Tumors with Somatostatin Analogues N. Engl. J. Med., August 24, 2000; 343(8): 551 - 554. [Full Text] [PDF]