Treatment of carcinoid syndrome - A prospective crossover evaluation of lanreotide versus octreotide in terms of efficacy, patient acceptability, andtolerance
D. O'Toole et al., Treatment of carcinoid syndrome - A prospective crossover evaluation of lanreotide versus octreotide in terms of efficacy, patient acceptability, andtolerance, CANCER, 88(4), 2000, pp. 770-776
BACKGROUND. The somatostatin analogues lanreotide and octreotide have previ
ously been shown to be effective in controlling flushing and diarrhea in p
atients with carcinoid syndrome. As lanreotide requires injection only ever
y 10 days, compared with twice-daily injections of octreoeide, a direct com
parison between these two treatments in terms of patient acceptability, pat
ient preference, and efficacy in controlling symptoms was performed in pati
ents with carcinoid syndrome.
METHODS. Thirty-three patients with carcinoid syndrome were included in an
open, multicenter, crossover study. Waif of the patients received octreotid
e 200 mu g subcutaneously twice or thrice daily for 1 month followed by lan
reotide 30 mg intramuscularly every 10 days for 1 month, while the other ha
lf commenced with lanreotide followed by octreotide in a similar fashion. Q
uality-of-life assessments were performed at each visit and patient prefere
nce for one of the two treatments evaluated. The number and intensity of fl
ushing episodes and bowel movements, urinary 5-hydroxyindoleacetic acid (5H
IAA) levels, and plasma serotonin levels were recorded.
RESULTS. No significant differences were found between lanreotide and octre
otide in terms of quality of life. The majority of patients (68%) preferred
lanreotide (P = 0.03), largely due to its simplified mode of administratio
n. Disappearance or improvement in flushes, occurred in 53.8% of patients (
14 of 26) while on lanreotide and in 68% (17 of 25) on octreotide. A disapp
earance or improvement of diarrhea in 45.4% (10 of 22) on lanreotide, compa
red with 50% (11 of 22) on octreotide, was also observed. Lanreotide and oc
treotide were equally effective in reducing urinary 5HIAA levels and plasma
serotonin levels. Both treatments were well tolerated, with mild symptoms
of abdominal pain and nausea observed in 29% and 14% receiving octreotide a
nd lanreotide, respectively.
CONCLUSIONS. Lanreotide and octreotide are equally efficacious in terms of
symptom control and reduction in tumor cell markers for patients with carci
noid syndrome. Due to its simplified mode of administration. most patients
prefer treatment with lanreotide. (C) 2000 American Cancer Society.