Somatostatin analogs in the treatment of neuroendocrine tumors: current and emerging aspects

ABSTRACT

Introduction: Neuroendocrine tumors (NETs) harbor somatostatin receptors and there is a strong rationale for using somatostatin analogs (SSAs) for treatment of NETs.

Areas covered: This article discusses i) pharmacology of somatostatin and its analogs; ii) antisecretory and anti-proliferative effects of SSAs in NETs; iii) efficacy and safety of emerging therapeutic regimens with first generation SSAs administered at either high doses or in combination with antineoplastic drugs; iv) efficacy and safety of pasireotide and chimeric molecules; v) efficacy of radionuclide therapy of NETs using SSAs.

Expert opinion: SSAs are the first-line medical therapy for functioning and non-functioning well-differentiated NETs. In patients not responder to first generation SSAs, the increase of drug dose over the conventional regimens, the combination of SSAs with other biotherapies or molecular targeted therapies, the switch to pasireotide or the use of SSAs in radionuclide therapy may improve the therapeutic success.

KEYWORDS:

• Somatostatin analogs
• octreotide
• lanreotide
• pasireotide
• neuroendocrine tumors

Article highlights

• Octreotide LAR and lanreotide ATG are effective in inhibiting the cell proliferation and amine/peptide secretion of gastroenteropancreatic and pulmonary NETs.

• The up-titration of octreotide LAR and lanreotide ATG doses over the conventional regimens may increase the effectiveness of these drugs in patients with NETs.

• The efficacy and safety of SSAs in combination with other agents is still a matter of uncertainty which will be clarified by ongoing clinical trials.

• It is still unknown whether pasireotide may improve the management of NETs.

This box summarizes key points contained in the article.

Declaration of interest

A. Giustina is a consultant for Ipsen, Novartis, and Pfizer. G. Mazziotti received consulting fees from Novartis Farma and Ipsen and received lecture fee from Ipsen. 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. A reviewer on this manuscript has disclosed honoraria for lectures, advisory board participation and educational/research grants to their neuroendocrine tumor unit from Ipsen and Novartis. All other peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.