VIPoma medical therapy: Difference between revisions
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{{CMG}}{{AE}}{{MSI}}{{PSD}} | {{CMG}}{{AE}}{{MSI}}{{PSD}} | ||
==Overview== | ==Overview== | ||
Initial treatment in patient with VIPoma is prompt replacement of fluid and correction of electrolyte imbalance and acid-base disturbance.<ref name="sp">Vinik A. Vasoactive Intestinal Peptide Tumor (VIPoma) [Updated 2013 Nov 28]. In: De Groot LJ, Beck-Peccoz P, Chrousos G, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: http://www.ncbi.nlm.nih.gov/books/NBK278960/</ref> | Initial treatment in patient with VIPoma is prompt [[Fluid replacement therapy|replacement of fluid]] and correction of [[electrolyte imbalance]] and [[Acid-base disturbances|acid-base disturbance]].<ref name="sp">Vinik A. Vasoactive Intestinal Peptide Tumor (VIPoma) [Updated 2013 Nov 28]. In: De Groot LJ, Beck-Peccoz P, Chrousos G, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: http://www.ncbi.nlm.nih.gov/books/NBK278960/</ref> | ||
==Medical Therapy== | ==Medical Therapy== | ||
===Symptomatic treatment=== | ===Symptomatic treatment=== | ||
*Initial treatment in patient with VIPoma is prompt replacement of fluid and electrolyte losses. The IV fluid of choice is isotonic normal saline with added potassium and bicarbonate as necessary. | *Initial treatment in patient with VIPoma is prompt [[Fluid replacement therapy|replacement of fluid]] and [[Electrolyte disturbance|electrolyte losses]]. | ||
*[[Sandostatin|Somatostatin]] analogues like short acting [[octreotide]] (50-100mcg every 8 hours) are useful for controlling diarrhea by blocking the release of VIP. [[Octreotide]] is later replaced by longer acting depot preparation of somatostatin analogues like sandostatin (20 mg IM every 4 weeks) and | *The IV fluid of choice is isotonic [[normal saline]] with added [[potassium]] and [[bicarbonate]] as necessary. | ||
*[[Sandostatin|Somatostatin]] analogues like short acting [[octreotide]] (50-100mcg every 8 hours) are useful for controlling [[diarrhea]] by blocking the release of [[Vasoactive intestinal peptide|VIP]]. | |||
*[[Octreotide]] is later replaced by longer acting depot preparation of somatostatin analogues like [[sandostatin]] (20 mg IM every 4 weeks) and lanreotide (120mg subQ every 4 weeks). | |||
*[[Steroids]] are used in diarrhea of VIPoma refractory to somatostatin (prednisone 60 mg per day).<ref name="pmid2545444">{{cite journal| author=O'Dorisio TM, Mekhjian HS, Gaginella TS| title=Medical therapy of VIPomas. | journal=Endocrinol Metab Clin North Am | year= 1989 | volume= 18 | issue= 2 | pages= 545-56 | pmid=2545444 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2545444 }}</ref> | *[[Steroids]] are used in diarrhea of VIPoma refractory to somatostatin (prednisone 60 mg per day).<ref name="pmid2545444">{{cite journal| author=O'Dorisio TM, Mekhjian HS, Gaginella TS| title=Medical therapy of VIPomas. | journal=Endocrinol Metab Clin North Am | year= 1989 | volume= 18 | issue= 2 | pages= 545-56 | pmid=2545444 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2545444 }}</ref> | ||
*[[Sunitinib]] (37.5 mg oral once a day) a tyrosin kinase inhibitor has some evidence of symptomatic and biochemical control in somatostatin analogue resistant VIPoma.<ref name="pmid27461388">{{cite journal| author=Dimitriadis GK, Weickert MO, Randeva HS, Kaltsas G, Grossman A| title=Medical management of secretory syndromes related to gastroenteropancreatic neuroendocrine tumours. | journal=Endocr Relat Cancer | year= 2016 | volume= 23 | issue= 9 | pages= R423-36 | pmid=27461388 | doi=10.1530/ERC-16-0200 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27461388 }}</ref><ref name="pmid23840053" /> It is also a medical treatment for locally advanced unresectable or advanced metastatic VIPoma. | *[[Sunitinib]] (37.5 mg oral once a day) a tyrosin kinase inhibitor has some evidence of symptomatic and biochemical control in somatostatin analogue resistant VIPoma.<ref name="pmid27461388">{{cite journal| author=Dimitriadis GK, Weickert MO, Randeva HS, Kaltsas G, Grossman A| title=Medical management of secretory syndromes related to gastroenteropancreatic neuroendocrine tumours. | journal=Endocr Relat Cancer | year= 2016 | volume= 23 | issue= 9 | pages= R423-36 | pmid=27461388 | doi=10.1530/ERC-16-0200 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27461388 }}</ref><ref name="pmid23840053">{{cite journal| author=Zhang J, Francois R, Iyer R, Seshadri M, Zajac-Kaye M, Hochwald SN| title=Current understanding of the molecular biology of pancreatic neuroendocrine tumors. | journal=J Natl Cancer Inst | year= 2013 | volume= 105 | issue= 14 | pages= 1005-17 | pmid=23840053 | doi=10.1093/jnci/djt135 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23840053 }}</ref> It is also a medical treatment for locally advanced unresectable or advanced metastatic VIPoma. | ||
*'''<u>Initial Management</u>''' | |||
** '''Preferred regimen (1)''' : [[Octreotide]] 50-100mcg q8h initially | |||
* '''<u>Maintenance dosage</u>''' | |||
** '''Preferred regimen (1)''': [[Sandostatin]] 20 mg IM every 4 weeks Lanreotide (120mg subQ every 4 weeks). '''(OR)''' | |||
** '''Preferred regimen (2)''': [[Lanreotide]] 120mg subcutaneously every 4 weeks. | |||
* '''<u>Refractory cases</u>''' | |||
** '''Preferred regimen (1)''': [[Prednisone]] 60 mg IM q24 for 1 week. | |||
** '''Preferred regimen (2)''': [[Sunitinib]] 37.5 mg PO q24h. | |||
===Medical management of advanced local or metastatic disease=== | ===Medical management of advanced local or metastatic disease=== | ||
*There has been limited use of chemotherapy in patients with VIPoma. However, [[streptozocin]] based chemotherapy is considered best. | *There has been limited use of chemotherapy in patients with VIPoma. However, [[streptozocin]] based chemotherapy is considered best in the management of advanced local or metastatic disease. | ||
*Most successful and favourable combination regimen of chemotherapy is | *Most successful and favourable combination regimen of chemotherapy is [[streptozocin]] with [[Doxorubicin hydrochloride|doxorubicin]] together with [[somatostatin]] analogues. | ||
*[[Fluorouracil|5-FU]] can be used as alternative to [[Doxorubicin hydrochloride|doxorubicin]] in patients with who have contraindications to [[Doxorubicin|doxorubucin]].<ref name="pmid15570077">{{cite journal| author=Kouvaraki MA, Ajani JA, Hoff P, Wolff R, Evans DB, Lozano R et al.| title=Fluorouracil, doxorubicin, and streptozocin in the treatment of patients with locally advanced and metastatic pancreatic endocrine carcinomas. | journal=J Clin Oncol | year= 2004 | volume= 22 | issue= 23 | pages= 4762-71 | pmid=15570077 | doi=10.1200/JCO.2004.04.024 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15570077 }}</ref> | |||
*Other molecular targeted therapy undergoing research for treatment are [[Everolimus]] (mTOR inhibitor) and [[Bevacizumab]] ( anti-VEGF monoclonal antibody).<ref name="pmid1310159">{{cite journal| author=Moertel CG, Lefkopoulo M, Lipsitz S, Hahn RG, Klaassen D| title=Streptozocin-doxorubicin, streptozocin-fluorouracil or chlorozotocin in the treatment of advanced islet-cell carcinoma. | journal=N Engl J Med | year= 1992 | volume= 326 | issue= 8 | pages= 519-23 | pmid=1310159 | doi=10.1056/NEJM199202203260804 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1310159 }}</ref> | *Other molecular targeted therapy undergoing research for treatment are [[Everolimus]] (mTOR inhibitor) and [[Bevacizumab]] ( anti-VEGF monoclonal antibody).<ref name="pmid1310159">{{cite journal| author=Moertel CG, Lefkopoulo M, Lipsitz S, Hahn RG, Klaassen D| title=Streptozocin-doxorubicin, streptozocin-fluorouracil or chlorozotocin in the treatment of advanced islet-cell carcinoma. | journal=N Engl J Med | year= 1992 | volume= 326 | issue= 8 | pages= 519-23 | pmid=1310159 | doi=10.1056/NEJM199202203260804 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1310159 }}</ref> | ||
==References== | ==References== | ||
Revision as of 20:08, 19 January 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Madhu Sigdel M.B.B.S.[2]Parminder Dhingra, M.D. [3]
Overview
Initial treatment in patient with VIPoma is prompt replacement of fluid and correction of electrolyte imbalance and acid-base disturbance.[1]
Medical Therapy
Symptomatic treatment
- Initial treatment in patient with VIPoma is prompt replacement of fluid and electrolyte losses.
- The IV fluid of choice is isotonic normal saline with added potassium and bicarbonate as necessary.
- Somatostatin analogues like short acting octreotide (50-100mcg every 8 hours) are useful for controlling diarrhea by blocking the release of VIP.
- Octreotide is later replaced by longer acting depot preparation of somatostatin analogues like sandostatin (20 mg IM every 4 weeks) and lanreotide (120mg subQ every 4 weeks).
- Steroids are used in diarrhea of VIPoma refractory to somatostatin (prednisone 60 mg per day).[2]
- Sunitinib (37.5 mg oral once a day) a tyrosin kinase inhibitor has some evidence of symptomatic and biochemical control in somatostatin analogue resistant VIPoma.[3][4] It is also a medical treatment for locally advanced unresectable or advanced metastatic VIPoma.
- Initial Management
- Preferred regimen (1) : Octreotide 50-100mcg q8h initially
- Maintenance dosage
- Preferred regimen (1): Sandostatin 20 mg IM every 4 weeks Lanreotide (120mg subQ every 4 weeks). (OR)
- Preferred regimen (2): Lanreotide 120mg subcutaneously every 4 weeks.
- Refractory cases
- Preferred regimen (1): Prednisone 60 mg IM q24 for 1 week.
- Preferred regimen (2): Sunitinib 37.5 mg PO q24h.
Medical management of advanced local or metastatic disease
- There has been limited use of chemotherapy in patients with VIPoma. However, streptozocin based chemotherapy is considered best in the management of advanced local or metastatic disease.
- Most successful and favourable combination regimen of chemotherapy is streptozocin with doxorubicin together with somatostatin analogues.
- 5-FU can be used as alternative to doxorubicin in patients with who have contraindications to doxorubucin.[5]
- Other molecular targeted therapy undergoing research for treatment are Everolimus (mTOR inhibitor) and Bevacizumab ( anti-VEGF monoclonal antibody).[6]
References
- ↑ Vinik A. Vasoactive Intestinal Peptide Tumor (VIPoma) [Updated 2013 Nov 28]. In: De Groot LJ, Beck-Peccoz P, Chrousos G, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: http://www.ncbi.nlm.nih.gov/books/NBK278960/
- ↑ O'Dorisio TM, Mekhjian HS, Gaginella TS (1989). "Medical therapy of VIPomas". Endocrinol Metab Clin North Am. 18 (2): 545–56. PMID 2545444.
- ↑ Dimitriadis GK, Weickert MO, Randeva HS, Kaltsas G, Grossman A (2016). "Medical management of secretory syndromes related to gastroenteropancreatic neuroendocrine tumours". Endocr Relat Cancer. 23 (9): R423–36. doi:10.1530/ERC-16-0200. PMID 27461388.
- ↑ Zhang J, Francois R, Iyer R, Seshadri M, Zajac-Kaye M, Hochwald SN (2013). "Current understanding of the molecular biology of pancreatic neuroendocrine tumors". J Natl Cancer Inst. 105 (14): 1005–17. doi:10.1093/jnci/djt135. PMID 23840053.
- ↑ Kouvaraki MA, Ajani JA, Hoff P, Wolff R, Evans DB, Lozano R; et al. (2004). "Fluorouracil, doxorubicin, and streptozocin in the treatment of patients with locally advanced and metastatic pancreatic endocrine carcinomas". J Clin Oncol. 22 (23): 4762–71. doi:10.1200/JCO.2004.04.024. PMID 15570077.
- ↑ Moertel CG, Lefkopoulo M, Lipsitz S, Hahn RG, Klaassen D (1992). "Streptozocin-doxorubicin, streptozocin-fluorouracil or chlorozotocin in the treatment of advanced islet-cell carcinoma". N Engl J Med. 326 (8): 519–23. doi:10.1056/NEJM199202203260804. PMID 1310159.