title: Clinical evaluation of SMS 201-995. Long-term treatment in gut neuroendocrine tumours, efficacy of oral administration, and possible use in non-tumoural inappropriate TSH hypersecretion.
abstract: Long-acting somatostatin analogues such as SMS 201-995 (Sandoz) are being evaluated in a wide range of clinical indications, including gut neuroendocrine tumours and acrogemaly. Long-term continuous SMS 201-995 treatment has achieved useful symptomatic improvement in diarrhoea in 4 patients with metastatic VIPomas who had relapsed following previous treatment. Clinical improvement has outlasted suppression of VIP secretion (suggesting an additional direct antisecretory action of SMS 201-995) and has occurred despite expansion of hepatic metastases. In 6 patients with tumours secreting gastrin and/or glucagon, secretion of these peptides was acutely inhibited by SMS 201-995. However, endocrine and clinical responses to chronic treatment have been less consistent. SMS 201-995 is active orally at doses of 4-8 mg and when given thrice-daily to 6 patients with active acromegaly, suppressed mean 24-h growth hormone levels by 51-88%. Despite significantly reduced plasma insulin concentrations, glucose tolerance did not deteriorate. SMS 201-995 was also effective in suppressing thyroid-stimulating hormone (TSH) and thyroid hormone secretion in a patient with mild thyrotoxicosis due to non-tumoural inappropriate TSH hypersecretion. In all cases SMS 201-995 treatment has been well tolerated and has few side-effects.
mesh_terms: D000172:Acromegaly / Q000097:blood / Q000188:drug therapy; D000236:Adenoma / Q000378:metabolism; D000328:Adult; D000368:Aged; D003967:Diarrhea / Q000188:drug therapy; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000188:drug therapy*; D005935:Glucagonoma / Q000097:blood / Q000188:drug therapy; D013006:Growth Hormone / Q000097:blood; D006801:Humans; D006980:Hyperthyroidism / Q000188:drug therapy / Q000209:etiology; D008113:Liver Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000188:drug therapy*; D015282:Octreotide; D010190:Pancreatic Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D010911:Pituitary Neoplasms / Q000378:metabolism; D013004:Somatostatin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013311:Streptozocin / Q000627:therapeutic use; D013972:Thyrotropin / Q000378:metabolism*; D014660:Vasoactive Intestinal Peptide / Q000097:blood; D003969:Vipoma / Q000097:blood / Q000188:drug therapy / Q000473:pathology; D015043:Zollinger-Ellison Syndrome / Q000097:blood / Q000188:drug therapy
chemical_list: D014660:Vasoactive Intestinal Peptide; D013004:Somatostatin; D013311:Streptozocin; D013972:Thyrotropin; D013006:Growth Hormone; D015282:Octreotide