Lanreotide Depot to Treat Gastroenteropancreatic Neuroendocrine Tumors in a US Community Oncology Setting: A Prospective, Observational Study

Comparative analysis of adverse event profiles of lanreotide and octreotide in somatostatin-responsive endocrine and neoplastic diseases

Lanreotide and Octreotide are used to treat various endocrine and neoplastic diseases. This study aims to compare the adverse event profiles of Lanreotide and Octreotide in somatostatin-responsive diseases using FAERS data. FAERS data from Q1 2004 to Q2 2024 were reviewed for AE reports related to Lanreotide and Octreotide. Reports were categorized using MedDRA system organ classes (SOCs). Disproportionality analysis was conducted using Reporting Odds Ratios (ROR), Proportional Reporting Ratios (PRR), and Information Components (IC) to identify significant AEs. The top 20 AEs for each drug were analyzed, and chi-square tests assessed differences in AE frequencies between the drugs. Detailed comparisons were made across gastrointestinal, cardiovascular, and neoplastic AEs. Lanreotide was more associated with gastrointestinal AEs, such as diarrhea (1457 reports) and cholelithiasis (198 reports), with a notable signal for cholelithiasis (ROR 12.03, 95% CI 10.46-13.85). Octreotide had higher reports of cardiovascular AEs, including systolic (1483 reports) and diastolic (541 reports) blood pressure increases. Additionally, Octreotide was linked to neoplasm progression (1735 reports) and more frequent malignant neoplasms. Injection site reactions, including pain and nodules, were more common with Lanreotide (ROR 19.09, 95% CI 17.2-21.19). Lanreotide and Octreotide exhibit distinct adverse event profiles, with gastrointestinal signals more frequently observed for Lanreotide, and cardiovascular/neoplastic signals more apparent for Octreotide. These patterns should be interpreted with caution due to limitations of the FAERS data.

Real-World Study of Lanreotide Autogel in Routine Practice in Patients with Gastroenteropancreatic Neuroendocrine Tumors (GEP-NETs) in Hong Kong and Taiwan

INTRODUCTION

There is a lack of data on the efficacy, effectiveness, and safety of lanreotide autogel in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs) of Chinese ethnicity. This noninterventional, retrospective study evaluated the effectiveness and safety of lanreotide autogel in patients of Chinese ethnicity with GEP-NETs in clinical practice.

METHODS

Patients' charts were abstracted from five hospitals in Hong Kong and Taiwan (July-September 2021), where lanreotide autogel is approved for treating GEP-NETs. Included patients were adults with unresectable, metastatic, or locally advanced GEP-NETs who received a first injection (index) of lanreotide autogel 120 mg between 01 January 2017 and 30 June 2020 (planned sample size: N = 30). Follow-up ran from index to a maximum of 48 (± 4) weeks or until disease progression, start of new antitumor treatment, or death. The primary endpoint was progression-free survival (PFS) rate at week 48 (±4), and secondary endpoints included PFS rate at week 24 (±4), estimated using Kaplan-Meier analyses. All analyses were descriptive.

RESULTS

Of 27 patients enrolled, 22 (81.5%) had 48 weeks of follow-up. Tumors of pancreatic origin were the most common (73.9%). PFS rate was 0.96 (95% confidence interval: 0.72 - 0.99) at 24 weeks and 0.82 (0.53-0.94) at 48 weeks. Overall, 74.1% patients experienced ≥ 1 treatment-emergent adverse event; none were serious. No deaths were reported.

CONCLUSIONS

Lanreotide autogel was well tolerated and showed good tumor control rate in a real-world setting. These findings align with results from previous studies in Caucasian, Japanese, and Korean patients, thus supporting lanreotide autogel for treating patients with GEP-NETs of Chinese ethnicity.

Subcutaneous Lanreotide Depot: A Diagnostic Pitfall in Neuroendocrine Tumor Imaging

Lanreotide depot, a long-acting somatostatin analog, improves progression-free survival in neuroendocrine tumor (NET) patients. However, persistent subcutaneous depots can appear as metastatic lesions on imaging, potentially leading to misdiagnosis. We report the case of a 70-year-old man with grade 2 NET (Ki-67: 5.9%) undergoing six years of lanreotide treatment. Follow-up imaging revealed stable primary disease. However, nodular lesions in the buttock were identified on the CT scan performed eight months after the start of treatment. A retrospective review of a CT scan taken two months after treatment initiation revealed that these nodules were already present and had gradually increased in number, allowing for their correct identification as persistent lanreotide depots. This case underscores the need for heightened diagnostic awareness to prevent unnecessary interventions and ensure accurate management.

Agonists, Antagonists and Receptors of Somatostatin: Pathophysiological and Therapeutical Implications in Neoplasias

Somatostatin is a peptide that plays a variety of roles such as neurotransmitter and endocrine regulator; its actions as a cell regulator in various tissues of the human body are represented mainly by inhibitory effects, and it shows potent activity despite its physiological low concentrations. Somatostatin binds to specific receptors, called somatostatin receptors (SSTRs), which have different tissue distributions and associated signaling pathways. The expression of SSTRs can be altered in various conditions, including tumors; therefore, they can be used as biomarkers for cancer cell susceptibility to certain pharmacological agents and can provide prognostic information regarding disease evolution. Moreover, based on the affinity of somatostatin analogs for the different types of SSTRs, the therapeutic range includes conditions such as tumors, acromegaly, post-prandial hypotension, hyperinsulinism, and many more. On the other hand, a number of somatostatin antagonists may prove useful in certain medical settings, based on their differential affinity for SSTRs. The aim of this review is to present in detail the principal characteristics of all five SSTRs and to provide an overview of the associated therapeutic potential in neoplasias.

Neuroendocrine Neoplasia: From Pathophysiology to Novel Therapeutic Approaches

Neuroendocrine neoplasia (NEN) represents a sensational field of modern medicine; immense progress in emerging biochemical, molecular, endocrine, immunohistochemical, and serum tumour markers of disease, respectively, which are part of early diagnosis, genetic testing, and multidisciplinary approaches [...].

Epidemiology of Neuroendocrine Neoplasms and Results of Their Treatment with [177Lu]Lu-DOTA-TATE or [177Lu]Lu-DOTA-TATE and [90Y]Y-DOTA-TATE-A Six-Year Experience in High-Reference Polish Neuroendocrine Neoplasm Center

Neuroendocrine neoplasms (NENs) are a group of neoplasms arising from neuroendocrine cells. The worldwide incidence and prevalence of the NENs are estimated to be 6/100,000 and 35/100,000, respectively. Those numbers are increasing every decade, requiring higher and higher diagnosis and treatment costs. Radioligand therapy (RLT) using beta-emitting radioisotopes is an efficient and relatively safe method of treatment, typically used as a second-line treatment. RLT tolerability is higher than other available pharmacotherapies (chemotherapy or tyrosine kinase inhibitors). Recent studies show an increase in overall survival among patients treated with RLT. The present study aimed to learn the epidemiology of NENs in Poland and assess the effectiveness of RLT in a high-reference center. A prospective analysis of 167 patients treated with RLT in one of Poland's highest-reference NEN centers was performed. The analysis covered 66 months of observation (1 December 2017-30 May 2023), during which 479 RLT single administrations of radioisotope were given. The standard procedure was to give four courses of [177Lu]Lu-DOTA-TATE alone, or tandem therapy-[177Lu]Lu-DOTA-TATE and [90Y]Y-DOTA-TATE. Grading analysis showed that most patients had non-functioning G2 NEN with a mean Ki-67 of 6.05% (SD ± 6.41). The most common primary tumor location was the pancreas. Over two-thirds of patients did undergo surgery due to primary tumors or distant metastases. The majority of patients were using lanreotide as a chronically injected somatostatin analog. Median progression-free survival (PFS) on somatostatin analogs was 21.0 (IQR = 29.0) months. Directly after the last course of RLT, disease stabilization was noted in 69.46% of patients, partial regression was noted in 20.36% of patients, complete regression was noted in 0.60% of patients, and progression was noted in 9.58% of patients. In long-term follow-up, the median observation time among patients who underwent four treatment cycles (n = 108) was 29.8 (IQR = 23.9) months. Stabilization of the disease was observed in 55.56% of the patients and progression was observed in 26.85% of the patients, while 17.59% of patients died. Median PFS was 29.3 (IQR 23.9), and the median OS was 34.0 months (IQR 16.0). The mean age of NEN diagnosis is the sixth decade of life. It takes almost three years from NEN diagnosis to the start of RLT. In long-term observation, RLT leads to disease stabilization in over half of the patients with progressive disease. No differences in PFS or OS depend on the radioisotope used for RLT. In Poland, organized coordination of NEN treatment in high-reference centers ensures the continuity of patient care.