Glucagonoma medical therapy: Difference between revisions
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{{CMG}}; {{AE}} {{PSD}}, {{MAD}} | {{CMG}}; {{AE}} {{PSD}}, {{MAD}} | ||
==Overview== | ==Overview== | ||
The predominant medical therapy for primary glucagonoma is [[Somatostatin|somatostatin analogs]] ([[octreotide]]). Metastatic tumors need [[Therapeutic embolization|hepatic artery embolization]], [[ | The predominant medical therapy for primary glucagonoma is [[Somatostatin|somatostatin analogs]] ([[octreotide]]). Metastatic tumors need [[Therapeutic embolization|hepatic artery embolization]], [[radiofrequency ablation]], and molecular therapy. | ||
== Management of Primary Tumor == | |||
* [[Somatostatin|Somatostatin analogs]] ([[octreotide]]) are the treatment of choice to control symptoms.<ref name="pmid25489112">{{cite journal| author=Rosenbaum A, Flourie B, Chagnon S, Blery M, Modigliani R| title=Octreotide (SMS 201-995) in the treatment of metastatic glucagonoma: report of one case and review of the literature. | journal=Digestion | year= 1989 | volume= 42 | issue= 2 | pages= 116-20 | pmid=2548911 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2548911 }}</ref> | * [[Somatostatin|Somatostatin analogs]] ([[octreotide]]) are the treatment of choice to control symptoms.<ref name="pmid25489112">{{cite journal| author=Rosenbaum A, Flourie B, Chagnon S, Blery M, Modigliani R| title=Octreotide (SMS 201-995) in the treatment of metastatic glucagonoma: report of one case and review of the literature. | journal=Digestion | year= 1989 | volume= 42 | issue= 2 | pages= 116-20 | pmid=2548911 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2548911 }}</ref> | ||
* [[Doxorubicin]] and [[streptozotocin]] have also been used successfully to selectively damage [[alpha cells]] of the pancreatic islets. | * [[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 | Preferred regimen (1): [[Octreotide]] 400 micrograms/day | ||
== Metastasis Therapy == | |||
=== [[Therapeutic embolization|'''Hepatic artery''' '''embolization''']] === | |||
*Hepatic arterial [[embolization]] is a palliative treatment in patients with symptomatic [[Hepatic metastasis|hepatic metastases]] who are not candidates for surgical resection. | *Hepatic arterial [[embolization]] is a palliative treatment in patients with symptomatic [[Hepatic metastasis|hepatic metastases]] who are not candidates for surgical resection. | ||
*[[Therapeutic embolization|Embolization]] can be performed via the infusion through an [[Angiography|angiography catheter]] into [[Hepatic artery|hepatic arteries]]. | *[[Therapeutic embolization|Embolization]] can be performed via the infusion through an [[Angiography|angiography catheter]] into [[Hepatic artery|hepatic arteries]]. | ||
=== '''[[Radiofrequency ablation]]''' === | |||
*[[Ablation]] can be performed [[percutaneously]] or [[Laparoscopic surgery|laparoscopically]] in patients with symptomatic hepatic metastases who are not candidates for surgical resection. | *[[Ablation]] can be performed [[percutaneously]] or [[Laparoscopic surgery|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.<ref name="pmid12967136">{{cite journal| author=Gupta S, Yao JC, Ahrar K, Wallace MJ, Morello FA, Madoff DC et al.| title=Hepatic artery embolization and chemoembolization for treatment of patients with metastatic carcinoid tumors: the M.D. Anderson experience. | journal=Cancer J | year= 2003 | volume= 9 | issue= 4 | pages= 261-7 | pmid=12967136 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12967136 }}</ref> | *Ablation is applicable only to smaller lesions less than 3 cm.<ref name="pmid12967136">{{cite journal| author=Gupta S, Yao JC, Ahrar K, Wallace MJ, Morello FA, Madoff DC et al.| title=Hepatic artery embolization and chemoembolization for treatment of patients with metastatic carcinoid tumors: the M.D. Anderson experience. | journal=Cancer J | year= 2003 | volume= 9 | issue= 4 | pages= 261-7 | pmid=12967136 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12967136 }}</ref> | ||
=== '''Molecular therapy''' === | |||
*[[Sunitinib]] is a | *[[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. | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 16:52, 20 November 2017
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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.[1]
- 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.[2]
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.
References
- ↑ Rosenbaum A, Flourie B, Chagnon S, Blery M, Modigliani R (1989). "Octreotide (SMS 201-995) in the treatment of metastatic glucagonoma: report of one case and review of the literature". Digestion. 42 (2): 116–20. PMID 2548911.
- ↑ Gupta S, Yao JC, Ahrar K, Wallace MJ, Morello FA, Madoff DC; et al. (2003). "Hepatic artery embolization and chemoembolization for treatment of patients with metastatic carcinoid tumors: the M.D. Anderson experience". Cancer J. 9 (4): 261–7. PMID 12967136.