Retrospective Database Analysis Studies Somatostatin Analog Usage in NETs

Mathew Shanley

Last week at the 10th North American Neuroendocrine Tumor Society (NANETS) Annual Symposium in Philadelphia, Andrew J. Klink, PhD, Manager of Health Economics and Outcomes Research at Cardinal Health and colleagues shared results from a retrospective database analysis of somatostatin analog (SSA) usage in neuroendocrine tumors (NETs).

NETs are an uncommon cancer type, originating in the body’s neuroendocrine cells; often in the gastrointestinal tract, lungs or pancreas. Symptoms can vary among patients NETs, however, gastrointestinal issues are a typical complaint. SSAs are intended to prevent the body from producing an excess of hormones. Additional benefit can include the reduction of carcinoid syndrome-like symptoms and a slowing of tumor growth.
The objective of the observational study involving patients with metastatic NETs was to better comprehend SSA dose and frequency patterns, given the previously reported dose escalations with octreotide LAR that appear to be more effective even though the doses exceed current recommendations.

The study assessed 548 patients with a diagnosis of metastatic NETs who had been treated with octreotide LAR or lanreotide depot between January 1, 2015 and December 31, 2015 and were older than 18 years. Patients were classified into 1 of 2 treatment groups based on the first SSA used after their diagnosis, and descriptive statistics were calculated for the 2 treatment groups to summarize baseline demographics, clinical characteristics, treatment patterns, and healthcare resource utilization.

Of the 548 patients evaluated, 108 were on lanreotide depot and 440 were on octreotide LAR. The mean age at the start of SSA therapy for the lanreotide depot cohort was 61.9 years, and for the octreotide LAR cohort was 62.8 years. Carcinoid syndrome differed greatly among the 2 cohorts, being exhibited in 19.8% of patients taking octreotide LAR and 11.1% of patients being given lanreotide depot.

The most usual maximum dose and frequency among those treated with octrotide LAR was 30mg/4 weeks (48.9%) followed by 20mg/4 weeks (20.6%). Octreotide LAR was established to be used above suggested doses in 11.9% of patients. Only 1 patient treated with lanreotide depot received a dose above recommendations.

While dose escalations and deviations were both more common among octreotide LAR patients than lanreotide depot patients, the data showed that many patients received a maximum octreotide LAR dose below the dose studied to control tumor progression.

Supplementary examination into NET treatment patterns is necessary with longer term patient follow-up and continued monitoring as the NET treatment landscape continues to grow, and evidence for variances in carcinoid syndrome and healthcare resource use suggest that clinicians use the different SSAs in line with FDA indications.

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Klink AJ, et al. Somatostatin Analog Usage in Neuroendocrine Tumors: A Retrospective Database Analysis. Presented at the 10th NANETS Annual Meeting; Philadelphia PA; October 20 – 22, 2017.

Image Courtesy of WikiMedia Commons / By Yale Rosen from USA - Peripheral typical carcinoid tumor - CT scan - Case 266
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