Use of octreotide long acting repeatable (LAR) as second-line therapy in advanced neuroendocrine tumors in different clinical settings: an Italian Delphi survey

ABSTRACT

Background

Somatostatin receptor ligands including octreotide LAR are first-line therapy in locally advanced or metastatic NETs that are nonresectable and well differentiated and are recommended as first-line therapy in functioning and in G1/low G2 nonfunctioning NETs. However, several questions remain that are not adequately addressed in current guidelines regarding its use in clinical scenarios in which the tumor progresses. These include use of nonconventional doses or schedules of octreotide LAR in tumors with hormonal symptoms or showing clinical-radiological progression, administration in combination with everolimus, peptide receptor radionuclide therapy, and chemotherapy, following first-line treatment with octreotide LAR.

Methods

An expert panel was gathered to obtain consensus using Delphi methodology on a series of statements regarding further administration of octreotide LAR after its use in first-line therapy in these settings in patients who experience disease progression.

Results

Consensus was reached for 8 of the 10 statements proposed in the above clinical scenarios; consensus was not achieved for two statements.

Conclusions

The present statements aim to fill current gaps in treatment guidelines by providing recommendations based on expert consensus in clinical settings in which patients progress following first-line therapy with octreotide LAR.

KEYWORDS:

• Octreotide LAR
• second-line therapy
• advanced neuroendocrine tumors
• consensus
• delphi technique

Acknowledgments

Writing and editing support utilized in this manuscript and was provided by Content Ed Net, with the helpful assistance of Patrick Moore of Adriatic Health Communications and was funded by Novartis Farma. The authors would also like to thank following experts for their participation: Giuseppe Badalamenti, Alfredo Berruti, Antonio Bianchi, Davide Campana, Sara Cingarlini, Antoniogiulio Faggiano, Dario Giuffrida, Sara Massironi, Francesco Panzuto, Sara Pusceddu, Nando Riccardi, Salvatore Tafuto, and Maria Chiara Zatelli.

Declaration of interest

N Fazio declares that he has participated on advisory boards and has received served as a public speaker for Novartis, Ipsen, Pfizer, Merck Serono, Advanced Accelerator Applications, Merck Sharp and Dohme, Sanofi and Wren Laboratories Europe. He also declares institutional financial interests via clinical trial participation (either as a principal investigator or as part of the steering committee) for Novartis, Ipsen, Merck Serono, Merck Sharp and Dohme, Pharmacyclics, Incyte, Halozyme, Roche, Astellas, Pfizer Inc, FivePrime, and BeiGene. M Fazio is also the advisory board chairman of the European Neuroendocrine Tumor Society (ENETS), a referee of the neuroendocrine neoplasm guidelines for the Italian Association of Medical Oncology (AIOM), a scientific committee member for ITaNET and is the chair of NEN advanced course and NEN preceptorships for ESMO. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

One referee declares that they have conducted research with Novartis and has served as a scientific advisor. Another referee declares that they have received research grants from Novartis as well as speaker’s honoraria from Novartis and Ipsen. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Author contributions

All authors equally contributed to the conception of the project, literature searches, and drafting, critical revision, and editing of the manuscript, as well as final approval. All authors agree to be accountable for all aspects of the work.

Additional information

Funding

This project was supported by Novartis Farma, Italy. Novartis had no role in study design, collection of evidence, interpretation of data, writing the manuscript, or decision to publish.