Medical treatment of gastrinomas.
Gastrinomas are functional neuroendocrine tumors of the gastroenteropancreatic system. Surgery is first line treatment in gastrinomas, however often fails to be curative. This manuscript reviews current strategies of medical treatment of surgically non-curable gastrinoma. Symptomatic treatment with H(+)-K(+)-ATPase proton-pump inhibitors suppresses hypersecretion of gastric acid and substantially improves quality of life in patients with Zollinger-Ellison syndrome. Further medical therapy is only recommended in cases of progressive metastatic gastrinoma. In well differentiated neuroendocrine carcinoma (G1 and G2) a so-called biotherapy with somatostatin analogues exists as first-line and chemotherapy with streptocotozin plus doxorubicine/5-FU as second-line medical treatment option. In poorly differentiated neuroendocrine carcinoma (G3) chemotherapy with etoposide plus cisplatin is possible. Prospective future therapeutic strategies may include treatment with novel somatostatin analogues as well as angiogenesis inhibitors and kinase inhibitors targeting tumor-specific signaling cascades.
Auernhammer
Christoph J
CJ
Department of Internal Medicine II, Hospital of the University of Munich, Ludwig-Maximilians-University Munich, Munich-Grosshadern, Germany.
Göke
Burkhard
B
D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D004379:Duodenal Neoplasms / Q000097:blood / Q000188:drug therapy*; D015408:Gastrinoma / Q000097:blood / Q000188:drug therapy*; D005755:Gastrins / Q000097:blood*; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use; D015282:Octreotide / Q000627:therapeutic use; D010190:Pancreatic Neoplasms / Q000097:blood / Q000188:drug therapy*; D010456:Peptides, Cyclic / Q000627:therapeutic use; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D013004:Somatostatin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D015043:Zollinger-Ellison Syndrome / Q000097:blood / Q000188:drug therapy*
D020533:Angiogenesis Inhibitors; D005755:Gastrins; D016898:Interferon-alpha; D010456:Peptides, Cyclic; D054328:Proton Pump Inhibitors; C060347:lanreotide; D013004:Somatostatin; D015282:Octreotide