It’s that time of the month again — the regularly scheduled visit to the primary oncologist for a carcinoid symptom check-in, blood work, labs and the dreaded Shot of octreotide.
Ok, maybe “dreaded” is a bit overkill, as it’s just an intramuscular shot in the buttocks — nothing crazy or excessively painful — but it still involves getting poked with a needle and a bit of pain and discomfort at the injection site that can last for a few days. Some patients experience side effects of varying degrees of severity as well.
For patients with NET cancer, the primary location of disease, stage and grade determine the most appropriate treatment path. In addition to traditional cancer treatments that most people are familiar with — chemotherapy and radiation — there are new targeted therapies on the horizon, including Peptide Receptor Radionuclide Therapy (PRRT), as well as surgical procedures and regular injections of a somatostatin analogue (SSA) — either octreotide (Sandostatin) or lanreotide (Somatuline Depot) — which are synthetic versions of the naturally occurring hormone, somatostatin.
For Mark, his primary tumor was in the small intestine and, despite metastases to the mesentery, lymph nodes and liver, his disease is slow growing and the tumors have been well-differentiated. The treatment path he has been on so far has been positive for him. After two major surgeries, his only treatment has been monthly shots of octreotide. And based on his latest imaging scan, there has been no change in his tumor landscape, which means something is going right!
Somatostatin analogues (SSA) like octreotide play an important role in treating patients with NET cancer. Their mechanism of action is to bind to the somatostatin receptors that are overexpressed on the surfaces of tumor cells. This binding inhibits the release of excessive hormones, peptides and amines by the tumor cells, thereby alleviating symptoms of carcinoid syndrome, a set of clinical symptoms including facial flushing, diarrhea and less commonly, shortness of breath. In addition, this mechanism and its impact on slowing tumor growth is currently being explored, but anecdotally, there appears to be a positive correlation.
Our experience has been with octreotide, but another SSA that is often used is lanreotide. For more information about lanreotide and octreotide, check out this highly informative blog post — in addition to his other blog posts about NET cancer.
Before every injection, the medical staff shows the box of octreotide to the patient to confirm that all is correct. Sandostatin LAR Depot: Sandostatin (brand name for octreotide) LAR Depot is a long-acting version that is given as an intramuscular injection in the buttocks every 28 days by a healthcare provider. For patients with NET cancer, octreotide is indicated for the long-term treatment of severe diarrhea and flushing associated with metastatic carcinoid tumors and for the long-term treatment of watery diarrhea associated with vasoactive intestinal peptide (VIP)-secreting tumors. Of note, octreotide’s effect on tumor size and metastases growth rate has not been determined, but recent studies have shown a positive effect. Somatuline Depot Injection (brand name for lanreotide) is also given every 28 days by a healthcare provider, but it is administered as a deep subcutaneous injection (below the skin and not into the muscle) in the upper area of the buttocks. It is indicated to improve progression-free survival (the length of time without worsening of disease) for patients with unresectable, well- or moderately-differentiated, locally advanced or metastatic gastroenteropancreatic tumors.