Cancer Treatment Today

Both Afinitor (everolimus) and octreotide are FDA approved for neuroendocrine cancer. The phase III RADIANT-2 trial conducted in 429 patients with advanced neuroendocrine tumors (NETs) previously established that the addition of everolimus to long-acting octreotide led to a clinically meaningful 5.1-month delay in disease progression compared with octreotide alone. However, this value just missed the prespecified boundary for statistical significance

Lay Summary: Chemotherapy is not very useful for neuroendocrine cancers. A new promising drug, avastin, is being studied. Used as second-line therapy in combination with trastuzumab (Herceptin®) if previously treated with Herceptin® (trastuzumab) based therapy and has NOT previously received pertuzumab Response to chemotherapy in patients with strongly positive carcinoid tumours was of the order of only 10% whereas patients with SSRS negative tumours

Octreotide is a synthetic analog of the hormone somatostatin which exerts its effects through binding to somatostatin receptors subtype 2 and, to a lesser extent, 3 and 5. In carcinoid tumours, long-term administration of octreotide can control clinical symptoms due to hypersecretion of hormones. In addition, it may have some anti-proliferative effects. Patients who benefit from octreotide include those with functioning NETs of the gut or pancreas.

Neuroendocrine tumors are a rare and heterogeneous group of tumors with a variety of primary origins and variable aggressiveness. Platinum-based chemotherapy has been the cornerstone of treatment for the poorly differentiated tumors. However, well-differentiated neuroendocrine tumors are quite chemoresistant and therapy options are limited. Octreotide analogs and tyrosine kinase inhibitors are widely acceptable treatments due to substantial efficacy

There is evidence that the MTOR pathway plays an important role in renal cell cancer. It is also effective in neuroendocine cancer. Treatment with Afinitor® (everolimus) Tablets in combination with Sandostatin® LAR® (octreotide) produced good results in a study presented at the 11th World Congress on Gastrointestinal Cancer in Barcelona, Spain, in 2009.84% of patients with advanced pancreatic neuroendocrine tumors (NET) who took Afinitor® combined

A Phase III study in 2008   concluded that Sunitinib has antitumor activity in pancreatic neuroendocrine tumors; its activity against carcinoid tumors could not be definitively determined in this nonrandomized study. An editorial by Bajetta et al in the Journal of Clinical Oncology questioend whether results for neuroendocrine cancer can be generalized to the more benign carcinoid subtypes. The Phase III clinical trial was among 171 patients who

FDG PET is not all that sensitive in neuroendocrine cancers(NET). One study revealed that for neuroendocrine tumors, 18F-FDOPA was more accurate (sensitivity, 100%; specificity, 91%) in the detection of skeletal lesions than octreotide scintigraphy or CT but was insensitive (sensitivity, 20%; specificity, 94%) in the lung, ostensibly because of respiratory motion during image acquisition. Octreotide scintigraphy yielded its best results in the liver

SIRT -- a therapy that consists of millions of microscopic, radioactive glass microspheres (20-30 microns diameter) -- is infused into the arteries that feed inoperable liver tumors or metastatic cancer to the liver, bathing the malignancy in high levels of extremely localized radiation. In some studies of highly selected patients the response rates and stabilization rates ranged between 20-40 percent. Selective internal radiation therapy (SIRT)

Lay Sumamry: Interferon is an accepted treatment for carcinoid. Systemic treatment for NETs includes therapy with somatostatin analogs, interferon-alfa and cytotoxic agents. In addition, other agents can be useful, including loperamide for diarrhea or H1 or H2 blockers for histamine-secreting tumours. Interferon-alfa may be considered in selected cases to control clinical symptoms of hormone hyper-secretion. Symptomatic and biochemical responses

Everolimus has been approved by the US Food and Drug Administration (FDA) as the first oral, daily therapy (5 mg and 10 mg tablets) to treat advanced kidney cancer after failure of treatment with sunitinib or sorafenib. New data demonstrate that treatment with Afinitor® (everolimus) in combination with Sandostatin® LAR® (octreotide acetate suspension for injection) and Afinitor monotherapy may have the potential to stabilize tumour growth in patients