INCIDENCE AND MORBIDITY OF CHOLELITHIASIS IN PATIENTS RECEIVING CHRONIC OCTREOTIDE FOR METASTATIC CARCINOID AND MALIGNANT ISLET-CELL TUMORS

BAGKGROUND. Octreotide, a long-acting somatostatin analogue, has demon strated clinical utility in patients with carcinoid syndrome and malig nant islet cell tumors of tile pancreas. Prior studies have reported a greater than expected incidence of cholelithiasis in patients treated with octreotide for acromegaly. This study attempted to determine the incidence and morbidity of cholelithiasis in a group of patients with metastatic carcinoid or malignant pancreatic islet cell tumors whet w ere receiving chronic therapy with octreotide. METHODS. Forty-four of 55 patients on investigational protocols with octreotide were eligible for chart review; 10 patients were excluded due to prior cholecystect omy and 1 patient due to asymptomatic cholelithiasis at presentation, Patients fell into three treatment groups. The low dose (LD) group was comprised of 17 patients receiving 150 mu g of subcutaneous octreotid e 3 times a day. Twenty-one patients received high dose (HD) therapy c omprised of 500 mu g given 3 times a day. The low dose-high dose (LD-H D) group was comprised of 6 patients who had their dose escalated from 150 mu g to 225-500 mu g of octreotide 3 times a day. RESULTS. The ov erall incidence of cholelithiasis and/or gallbladder sludge was found to be 52.3% in all 3 treatment groups. Three of the 44 patients (6.8%) had symptomatic disease requiring emergency cholecystectomy. Five oth er patients underwent elective or incidental gallbladder surgery. The incidence of cholelithiasis in the LD, LD-HD, and HD groups was 35.3%, 66.6%, and 61.9%, respectively. The incidence of acute cholecystitis ill the three groups was 11.8%, 0%, and 4.8%, respectively. CONCLUSION S. Although greater than 50% of patients receiving octreotide develope d cholelithiasis, a much smaller percentage of patients had symptomati c gall bladder disease. Patients receiving chronic octreotide treatmen t require monitoring for the development of gallstones. However, proph ylactic cholecystectomy is not indicated, unless it is performed in co njunction with bowel resection or cytoreductive hepatic surgery. (C) 1 997 American Cancer Society.