Somatostatin Analog Therapies

To date, in appropriate patients, somatostatin analogs are the only proven therapy for the management of hormonal symptoms resulting from NETs. In addition, some studies have shown that somatostatin analog treatment may also help to stabilize disease in patients with NETs. Clinical trials with somatostatin analogs have shown that they have antiproliferative properties which can stop the growth of cancer cells, confirming their benefit for patients with well-differentiated advanced disease.

Administration of Lanreotide
The route of administration of the lanreotide gel formulation is via deep subcutaneous (under the skin) injection.

Administration of Octreotide
The route of administration is usually via one of three different routes: subcutaneous (just under the skin) injection; continuous subcutaneous infusion delivered with the use of a pump; and a long-acting, slow release formulation delivered intramuscularly. Each option has advantages and disadvantages, which your doctor can discuss with you.

Since the immediate-release form of octreotide remains active in the body for only a very short time, long-acting release (LAR) formulations have been developed to allow some patients to receive a deep subcutaneous or intramuscular injection only once per month. LAR formulations of octreotide and lanreotide are now considered the “standard of care”. Treatment is always modified to meet the patient’s specific needs, based on the recurrence of symptoms (if any) and the results of hormone level testing.

Lanreotide acetate – Somatuline

Somatuline Autogel (lanreotide) is indicated for the treatment of enteropancreatic neuroendocrine tumours in patients with grade 1 or a subset of Grade 2 (equivalent to Ki67 <10%) unresectable, locally advanced or metastatic disease to delay progression
The recommended dose of Somatuline Autogel is 120 mg administered every 4 weeks by deep subcutaneous injection in the superior external quadrant of the buttock. Treatment with Somatuline Autogel should be discontinued upon disease progression.

Administration The injection may be given by a healthcare professional or, for patients considered by their healthcare professional to be on a stable dose of Somatuline Autogel, by another appropriately trained individual. Alternatively, such patients may self-administer the product after appropriate training. The decision regarding administration by the patient or a trained individual should be taken by the healthcare professional.

BC – Funded + pituitary tumours
AB – N Funded
SK – Funded
MB – Funded
ON – Funded
QC – Funded
NS – Funded
NB – N Funded
NL – Funded
PEI – N Funded
The effectiveness of Somatuline Autogel is based on a phase 3 placebo-controlled trial which demonstrated a benefit in progression-free survival in patients classified with stable disease by RECIST criteria (<20% growth) over 12 to 24 weeks. There was no evidence of an overall survival benefit. Data on hindgut tumours were limited (see CLINICAL TRIALS).

lanreotide improves progression-free survival but not overall survival in patients with neuroendocrine tumors grade 1-2 R

Reference – CLARINET trial (N Engl J Med 2014 Jul 17;371(3):224)

Lanreotide Somatuline  Ipsen IPSEN CARES

1-855-215-2288

Hours: 8:00AM – 8:00PM ET

CLARINET Study slide presentation

CLARINET Study results

Octreotide – Sandostatin (subcutaneous and intravenous infusion)

Carcinoid Tumors
SANDOSTATIN* is indicated for the symptomatic treatment of metastatic carcinoid tumors where it suppresses or inhibits the severe diarrhea and flushing episodes associated with the disease.
Vasoactive Intestinal Peptide Tumors (VIPomas)

SANDOSTATIN* is indicated for the treatment of the profuse watery diarrhea associated with VIP-secreting tumors. Significant improvement has been noted in the overall condition of these otherwise therapeutically unresponsive patients. Therapy with SANDOSTATIN* results in improvement in electrolyte abnormalities, e.g., hypokalemia, often enabling reduction of fluid and electrolyte support.

Solution in ampoules (1 mL): 50μg/mL, 100 μg/mL, 500 μg/mL or
Multidose Vials (5 mL):
200 μg/ mL immediate-release formulation may be given subcutaneously or IV dose individualized by patient response and tolerance
– initial subcutaneous dose for carcinoid tumors 100-600 mcg/day in 2-4 divided doses
– median maintenance dose for carcinoid tumors 450 mcg/day, but doses to achieve benefit have ranged from 50 mcg to 1,500 mcg
– IV dosing for carcinoid crisis 50-500 mcg bolus (repeated as needed) or 50 mcg/hour for 8-24 hours
– subcutaneous dosing for prophylaxis of carcinoid crisis 250-500 mcg 1-2 hours before anesthetic induction, or 150-250 mcg every 6-8 hours 24-48 hours before anesthetic induction or chemotherapy
BC – Funded
AB – Funded
SK – Funded
MB – Funded
ON – Funded
QC – Funded
NS – Funded
NB – Funded
NL – Funded
PEI – Funded
Octreotide long-acting release lengthens time to tumor progression in patients with metastatic midgut neuroendocrine tumors.
Reference – PROMID Trial – J Clin Oncol 2009 Oct 1;27(28):4656

Octreotide acetate reported to relieve symptoms of carcinoid syndrome in patients with metastatic carcinoid tumors
Reference – N Engl J Med 1986 Sep 11;315(11):663

Octreotide long-acting release reported to relieve symptoms of carcinoid syndrome in patients with metastatic carcinoid tumors.
Reference – Aliment Pharmacol Ther 2003 Feb;17(3):437

Octreotide Sandostatin Novartis Novartis ACCESS Program

1-866-281-4688

Hours: 8:00AM – 6:00PM ET

PROMID Study results

Octreotide acetate – Sandostatin LAR (intramuscular)

Carcinoid Tumours
SANDOSTATIN* LAR* is indicated for the treatment of the severe diarrhea and flushing episodes associated with carcinoid tumors in patients in whom symptoms are adequately controlled on s.c. treatment with SANDOSTATIN*.

Vasoactive Intestinal Peptide Tumors (VIPomas)
SANDOSTATIN* LAR* is indicated for the treatment of the profuse watery diarrhea associated with VIP-secreting tumors in patients in whom symptoms are adequately controlled on s.c. treatment with SANDOSTATIN*. In patients with carcinoid syndrome and VIPomas, the effect of SANDOSTATIN* LAR* on tumor size and rate of growth has not been determined. In patients with carcinoid syndrome and VIPomas, the effect of SANDOSTATIN* LAR* on development of metastases has not been determined.

Initial dose 20 mg intramuscularly once every 4 weeks for 2 months, then may dose in range of 10-30 mg every 4 weeks.

10 mg Inj Kit Pk, 20 mg Inj Kit Pk, 30 mg Inj Kit Pk up to 60 every four weeks

BC – Funded
AB – Funded
SK – Funded
MB – Funded
ON – Funded
QC – Funded
NS – Funded
NB – Funded
NL – Funded
PEI – Funded
Octreotide long-acting release lengthens time to tumor progression in patients with metastatic midgut neuroendocrine tumors.
Reference – PROMID Trial – J Clin Oncol 2009 Oct 1;27(28):4656

Octreotide acetate reported to relieve symptoms of carcinoid syndrome in patients with metastatic carcinoid tumors
Reference – N Engl J Med 1986 Sep 11;315(11):663

Octreotide long-acting release reported to relieve symptoms of carcinoid syndrome in patients with metastatic carcinoid tumors.
Reference – Aliment Pharmacol Ther 2003 Feb;17(3):437

Octreotide acetate – Ocphyl

Carcinoid Tumors
OCPHYL is indicated for the symptomatic treatment of metastatic carcinoid tumors where it suppresses or inhibits the severe diarrhea and flushing episodes associated with the disease.
Vasoactive Intestinal Peptide Tumors (VIPomas)

OCPHYL is indicated for the treatment of the profuse watery diarrhea associated with VIP-secreting tumors. Significant improvement has been noted in the overall condition of these otherwise therapeutically unresponsive patients. Therapy with octreotide acetate results in improvement in electrolyte abnormalities, e.g. hypokalemia, often enabling reduction of fluid and electrolyte support.

50 g/mL, 100 g/mL and 500 g/mL
octreotide (as octreotide acetate) per 1 mL pre-filled syringe
BC – Funded
AB – Funded
SK – Funded
MB – Funded
ON – Not Funded
QC – Funded
NS – Funded
NB – Funded
NL – Funded
PEI – Not Funded