Intestinal Carcinoid Tumor Medication

Updated: Dec 20, 2021
  • Author: Rachel E Lewis, MD; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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Medication

Medication Summary

Pharmacotherapy is usually for symptomatic relief only. Chemotherapy response rates rarely exceed 30% and are usually short lived; chemotherapeutic regimens are best used for palliative purposes.

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Antineoplastic agents

Class Summary

These agents inhibit cell growth and differentiation.

Streptozocin (Zanosar)

Cell-cycle phase-nonspecific antineoplastic agent that alkylates DNA, causing interstrand cross-linking. Also inhibits DNA synthesis by blocking incorporation of DNA precursor and inhibiting cell proliferation. May be helpful in symptom palliation for patients with progressive disease. Dosage is related to body surface area. May cause a complete remission of disease. Administration must be suspended only when desired response or toxicity occurs. Streptozocin may determine severe nephrotoxic effects.

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Antisecretory agents

Class Summary

These agents may provide control of carcinoid symptoms.

Octreotide (Sandostatin)

Acts primarily on somatostatin receptor subtypes II and V. Inhibits GH secretion and has multitude of other endocrine and nonendocrine effects, including inhibition of glucagon, VIP, and GI peptides.

Telotristat ethyl (Xeromelo)

Telotristat, the active metabolite of telotristat ethyl, inhibits tryptophan hydroxylase, which mediates the rate limiting step in serotonin biosynthesis. Serotonin plays a role in mediating secretion, motility, inflammation, and sensation of the GI tract, and is overproduced in patients with carcinoid syndrome. It is indicated for carcinoid syndrome diarrhea in combination with somatostatin analog (SSA) therapy in adults inadequately controlled by SSA therapy.

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Somatostatin Analogs

Lanreotide (Somatuline Depot)

Used in treatment of carcinoid syndrome, to reduce frequency of rescue therapy, or for gastreoenteropancreatic neuroendocrine tumors, to improve progression-free survival.

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Biological Response Modifiers

Interferon alfa 2b (Interferon alfa-2b, Intron A)

Second-line therapy in functional NETs with low proliferation capacity, such as small intestinal carcinoids

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Radiopharmaceuticals

Lutetium Lu 177-dotatate (Lutathera)

Radiolabeled somatostatin analog; binds to somatostatin receptors with highest affinity for subtype 2 receptors (SSRT2). Upon binding to somatostatin receptor-expressing cells, including malignant somatostatin receptor-positive tumors, the compound is internalized. Beta emission from Lu 177 induces cellular damage by forming free radicals in somatostatin receptor-positive cells and in neighboring cells

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