USE OF OCTREOTIDE IN THE TREATMENT OF DIGESTIVE NEUROENDOCRINE TUMORS- 7-YEAR EXPERIENCE IN 20 CASES INCLUDING 9 CASES OF METASTATIC MIDGUT CARCINOID AND 5 CASES OF METASTATIC GASTRINOMA

The authors report their experience with octreotide in 20 patients (me dian age 57 years, 10 M, 10 F) from 1984 to 1991 ; 16 had metastatic A PUDoma: 1 PPoma with VIPoma, 1 glucagonoma, 5 gastrinoma including 1 a ssociated to PP-oma, 9 mid-gut carcinoid ; 3 patients had multiple-end ocrine neoplasia type I (MEN-I) with Zollinger-Ellison syndrome (ZES) and 1 patient a non-metastatic VIPoma. Octreotide (200-750 mug/day) wa s administered bid or tid with regular laboratory controls and morphol ogical assessment. There was a striking improvement of symptoms, parti cularly in the carcinoid group (reduction of flushing in all patients and of diarrhoea in 3/5), in the patient with gastrinoma + acromegaly (regression of congestive heart failure) and in the patient with non-m etastatic VIPoma. The hormonal markers were markedly reduced, particul arly gastrin, PP (except in the patient with PPoma + VIPoma), VIP, GH and Somatomedin-C and urinary 5HIAA in 4/9 patients with carcinoid. Th ere was only one partial regression of metastases (gastrinoma) and 4 a pparent stabilizations of tumour growth, in the 16 metastatic cases. A mong them, 4 patients died : 1 glucagonoma, 1 PPoma + VIPoma, 2 mid-gu t carcinoids after a treatment of 5, 16, 30, 36 months, respectively. The patient with acromegaly + ZES died after 6 years of treatment at a ge 81. A patient with prolactinoma, resected insulinoma, hyperparathyr oidism and ZES was not improved by a short course of octreotide (hypog lycemia) ; he died later of recurrent insulinoma. In conclusion, octre otide is a useful drug to control most of the symptoms related to gut endocrine tumours ; it may inhibit tumour growth.