Carcinoid syndrome medical therapy: Difference between revisions

Jump to navigation Jump to search
Line 37: Line 37:
The typical duration of treatment with somatostatin analogs is approximately 12 months because of the development of tachyphylaxis (reported less frequently with long-acting formulations) and/or disease progression.[15-17] In the management of carcinoid crises, intravenous somatostatin analogs are effective; crises are usually precipitated by anesthesia, surgical interventions, or radiologic interventions.[18] Adverse effects of somatostatin analog administration include:[19,20]
The typical duration of treatment with somatostatin analogs is approximately 12 months because of the development of tachyphylaxis (reported less frequently with long-acting formulations) and/or disease progression.[15-17] In the management of carcinoid crises, intravenous somatostatin analogs are effective; crises are usually precipitated by anesthesia, surgical interventions, or radiologic interventions.[18] Adverse effects of somatostatin analog administration include:[19,20]


Nausea.
[[Nausea]]
Cramping.
[[Cramping]]
Loose stools.
[[Loose stools]]
Steatorrhea.
[[Steatorrhea]]
Cardiac conduction abnormalities and arrhythmias.
Cardiac conduction abnormalities and [[arrhythmias]]
Endocrine disturbances (e.g., hypothyroidism, hypoglycemia, or, more commonly, hyperglycemia).
Endocrine disturbances (e.g., [[hypothyroidism]], [[hypoglycemia]], or, more commonly, [[hyperglycemia]])
Gastric atony (rarely).
Gastric atony


===Chemotherapy===
===Chemotherapy===

Revision as of 13:03, 22 September 2015

Carcinoid syndrome Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Carcinoid Syndrome from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Staging

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Carcinoid syndrome medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Carcinoid syndrome medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Carcinoid syndrome medical therapy

CDC on Carcinoid syndrome medical therapy

Carcinoid syndrome medical therapy in the news

Blogs on Carcinoid syndrome medical therapy

Directions to Hospitals Treating Carcinoid syndrome

Risk calculators and risk factors for Carcinoid syndrome medical therapy

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

Overview

For symptomatic relief of carcinoid sydromes medical therapy many include: octreotide, methysergide maleate, and cyproheptadine.

Medical Therapy

Standard treatments for patients with gastrointestinal (GI) carcinoid tumors include the following:

  • Surgery
  • Somatostatin analogs
  • Interferons
  • Treatment of hepatic metastases
  • Radionuclides
  • Management of carcinoid-related fibrosis

Symptomatic therapy Symptomatic relief may be provided by any of the following medical therapies:



Somatostatin Analogs

The development of long-acting and depot formulations of somatostatin analogs has been important in the amelioration of symptoms of carcinoid syndrome. The result has been a substantial improvement in quality of life with relatively mild adverse effects. Experimentally, somatostatin has been shown to have a cytostatic effect on tumor cells. This effect involves hyperphosphorylation of the retinoblastoma gene product and G1 cell cycle arrest, in addition to somatostatin receptor (SSTR) subtype 3 [sst(3)]-mediated (and to a lesser extent, SSTR subtype [sst(2)]-mediated) apoptosis. Somatostatin also appears to have some antiangiogenic properties. However, only a small number of patients treated with somatostatin analog therapy experience partial tumor regression.

Octreotide, a short-acting somatostatin analog and the first biotherapeutic agent used in the management of carcinoid tumors, exhibits beneficial effects that are limited to symptom relief, with about 70% of patients experiencing resolution of diarrhea or flushing.

In the treatment of carcinoids, lanreotide, a long-acting somatostatin analog administered every 10 to 14 days, has an efficacy similar to that of octreotide and an agreeable formulation for patient use.[13] The effects of lanreotide on symptom relief are comparable to those of octreotide, with 75% to 80% of patients reporting decreased diarrhea and flushing; however, there appears to be little improvement in tumor responses over shorter-acting octreotide.

Depot formulations include long-acting repeatable (LAR) octreotide and a slow-release depot preparation of lanreotide.

The typical duration of treatment with somatostatin analogs is approximately 12 months because of the development of tachyphylaxis (reported less frequently with long-acting formulations) and/or disease progression.[15-17] In the management of carcinoid crises, intravenous somatostatin analogs are effective; crises are usually precipitated by anesthesia, surgical interventions, or radiologic interventions.[18] Adverse effects of somatostatin analog administration include:[19,20]

Nausea Cramping Loose stools Steatorrhea Cardiac conduction abnormalities and arrhythmias Endocrine disturbances (e.g., hypothyroidism, hypoglycemia, or, more commonly, hyperglycemia) Gastric atony

Chemotherapy

Chemotherapy is of little benefit and is generally not indicated. Octreotide (a somatostatin analogue) may decrease the secretory activity of the carcinoid.

References


Template:WikiDoc Sources