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High-dose treatment with a long-acting somatostatin analogue in patients with advanced midgut carcinoid tumours
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Endocrine Oncology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Endocrine Oncology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemical endocrinology.
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2004 (English)In: European Journal of Endocrinology, ISSN 0804-4643, E-ISSN 1479-683X, Vol. 151, no 1, 107-112 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE:

High-dose somatostatin analogue treatment has shown an antiproliferative effect in one study including patients with neuroendocrine tumours. To explore this therapeutic strategy further, we have studied the effect of a high-dose formula of octreotide, octreotide pamoate, in midgut carcinoid patients.

DESIGN AND METHODS:

Twelve patients with advanced midgut carcinoid tumours with a median duration of disease of more than 5 years were included. All were in a progressive state despite several previous treatment modalities. Octreotide pamoate (160 mg) was given as an intramuscular injection every 2 weeks for 2 months and then monthly. Radiological and biochemical responses were monitored.

RESULTS:

Tumour size and biochemical markers were stabilised for a median of 12 months in 75% of the patients. Ten patients had symptomatic improvement of flush and diarrhoea.

CONCLUSION:

In this group of patients with advanced midgut carcinoid tumours and progressive disease, octreotide pamoate managed to improve symptoms, and stabilise hormone production and tumour growth in 75% of the patients. We believe that high-dose treatment with somatostatin analogues can be an important addition to the therapeutic arsenal for patients with advanced progressive midgut carcinoid tumours.

Place, publisher, year, edition, pages
2004. Vol. 151, no 1, 107-112 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-95343DOI: 10.1530/eje.0.1510107PubMedID: 15248829OAI: oai:DiVA.org:uu-95343DiVA: diva2:169518
Available from: 2007-01-19 Created: 2007-01-19 Last updated: 2017-01-25Bibliographically approved
In thesis
1. Midgut Carcinoid Tumours: New Diagnostic Procedures and Treatment
Open this publication in new window or tab >>Midgut Carcinoid Tumours: New Diagnostic Procedures and Treatment
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Midgut carcinoid tumours are rare with an incidence of 0.5-2.1/100 000. The primary tumour is usually small and grows slowly but has almost always set metastases at diagnosis. When radically operated, most patients will eventually recur in their disease.

We evaluated different methods in detecting recurrent disease in 61 malignant midgut carcinoid tumours that had been radically operated. Thirty-eight patients have been diagnosed with a recurrence. In 32/38 of these patients P-Chromogranin A was the first method to indicate a recurrence. We therefore recommend using P-CgA in the work up in these patients.

We investigated characteristics, survival and independent factors that could be of bad prognostic value. We found that in our 284 malignant midgut carcinoid tumours, 208/284 (73%) had distant metastases and 30/284 (11%) had carcinoid heart disease. Median survival was 115.5 months and five-year survival was 77%. In a multivariate analysis liver metastases and carcinoid heart disease were poor prognostic factors.

We performed a phase II study with octreotide pamoate investigating the clinical effect in 12 malignant midgut carcinoid tumours in a progressive phase. We found that 9/12 (75%) were stabilised for a median duration of 12 months. We think that this is a good effect considering the advanced stage.

We investigated the frequency of four different tyrosine kinase receptors, platelet derived growth factor receptor (PDGR) α and β, epidermal growth factor receptor (EGFR) and c-kit, in 36 malignant midgut carcinoid tumours with immunohistochemistry. We found that 13/34 (38%) tumour samples expressed PDGFRα, 29/33 (88%) PDGFRβ, 24/33 (73%) EGFR, whereas none expressed c-kit. This implicates that midgut carcinoid tumours might be susceptible to treatment with tyrosine kinase receptor inhibitors.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2007. 53 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 216
Keyword
Medicine, Midgut carcinoid tumour, Chromogranin A, Carcinoid heart disease, Survival, Octreotide pamoate, Tyrosine kinase receptors, Platelet derived growth factor receptor, Epidermal growth factor receptor, Medicin
Identifiers
urn:nbn:se:uu:diva-7436 (URN)978-91-554-6773-9 (ISBN)
Public defence
2007-02-09, Enghoffsalen, Ing 50 bv, Akademiska sjukhuset, Uppsala, 13:15
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Available from: 2007-01-19 Created: 2007-01-19Bibliographically approved

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Welin, StaffanJanson, Eva TiensuuSundin, AndersStridsberg, MatsGranberg, DanSkogseid, BrittÖberg, KjellEriksson, Barbro

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