Exocrine pancreatic insufficiency and somatostatin analogs in patients with neuroendocrine neoplasia

Figures & data

Table 1. Clinical studies on EPI and SSAs in patients with NENs

Reference	Study design	Population	Diagnosis of EPI	Main findings
Saif [7]	Retrospective	Patients with diagnosis of NEN	Steatorrhea QFFT No pancreatic disease	EPI prevalence 11.6% 100% improvement after PERT
Lamarca [8]	Prospective	Patients with well-differentiated NEN of any anatomical site	Stool FE ^−1 <200 μg/g or by a reduction of ≥21% of baseline value and/or development or worsening of symptoms	EPI prevalence 24% Median time to EPI: 2.9 months
Saif [9]	Retrospective	Patients with advanced well-differentiated GEP-NEN	Clinical signs of malabsorption (steatorrhea and weight loss) QFFT	EPI prevalence 38% Median time to EPI: 6.5 months
Rinzivillo [10]	Prospective	Patients with advanced well-differentiated (G1 or G2) GI NEN	Clinical signs of malabsorption and/or maldigestion (steatorrhea, weight loss, flatulence, and abdominal distention) Stool FE-1 <200 mcg/g	EPI prevalence 20% Glycated Hb predictor for EPI occurrence 100% improvement after PERT

Figure 1. Proposed algorithm to manage patients with GEP-NENs receiving SSAs. ¹Symptoms of maldigestion/malabsorption of nutrients; physical examination with anthropometry; circulating levels of nutrients including fat-soluble vitamins, proteins and micronutrients [glycemia, glycated hemoglobin, cholesterol, triglycerides, prealbumin, retinol-binding protein, 25-OH cholecalciferol (vitamin D), vitamin A, vitamin K, and minerals/trace elements, including serum iron, zinc, and magnesium]; noninvasive pancreatic functional test (FE-1 test). ²Standard dose of 40.000 PhU with main meals and half dose with snacks (increase dose according to clinical response)

Saif MW, Larson H, Kaley K, et al. Chronic octreotide therapy can induce pancreatic insufficiency: a common but under-recognized adverse effect. Expert Opin Drug Saf. 2010;9(6):867–873.

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Lamarca A, McCallum L, Nuttall C, et al. Somatostatin analogue-induced pancreatic exocrine insufficiency in patients with neuroendocrine tumors: results of a prospective observational study. Expert Rev Gastroenterol Hepatol. 2018;12(7):723–731.

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Saif MW, Romano A, Smith MH. et al. Chronic use of long-acting somatostatin analogues (SSAs) and exocrine pancreatic insufficiency (EPI) in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs): an under-recognized adverse effect. Cancer Med J. 2020;3(2):75–84.

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Rinzivillo M, De Felice I, Magi L, et al. Occurrence of exocrine pancreatic insufficiency in patients with advanced neuroendocrine tumors treated with somatostatin analogs. Pancreatology. 2020;20(5):875–879.

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