Glucagonoma medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2], Mohammed Abdelwahed M.D[3]

Overview

The predominant medical therapy for primary glucagonoma is somatostatin analogs (octreotide). Metastatic tumors need hepatic artery embolization, radiofrequency ablation, and molecular therapy.

Management of Primary Tumor

• Somatostatin analogs (octreotide) are the treatment of choice to control symptoms.
• Doxorubicin and streptozotocin have also been used successfully to selectively damage alpha cells of the pancreatic islets.

Drug regimen

Preferred regimen (1): Octreotide 400 micrograms/day

Metastasis Therapy

Hepatic artery embolization 

• Hepatic arterial embolization is a palliative treatment in patients with symptomatic hepatic metastases who are not candidates for surgical resection.
• Embolization can be performed via the infusion through an angiography catheter into hepatic arteries.

Radiofrequency ablation

• Ablation can be performed percutaneously or laparoscopically in patients with symptomatic hepatic metastases who are not candidates for surgical resection.
• Ablation is applicable only to smaller lesions less than 3 cm.

Molecular therapy 

• Sunitinib is a radio-labeled somatostatin analog which has a role in the management of glucagonoma's that are not symptomatic or have rapidly progressive metastasis.