title: Clinical benefits of above-standard dose of octreotide LAR in patients with neuroendocrine tumors for control of carcinoid syndrome symptoms: a multicenter retrospective chart review study.
abstract: BACKGROUND
  Octreotide LAR is used in patients for control of carcinoid syndrome (CS) and other symptoms of hormone hypersecretion. The aim of this study was to examine reasons for octreotide LAR dose escalation and observe CS symptom improvement in patients with neuroendocrine tumors (NETs) who underwent octreotide LAR dose escalation at three cancer referral centers.
  
  
  METHODS
  Medical records for patients with diagnosis of carcinoid or pancreatic NET who had received one dose or more of octreotide LAR above 30 mg every 4 weeks from 2000 to 2012 were reviewed. Reasons for dose escalation and symptomatic outcomes were abstracted for each patient 3 months prior to and up to 12 months following the dose escalation.
  
  
  RESULTS
  Of the evaluated 239 NET patients, 53% were male, mean age at first dose escalation was 60 years (standard deviation [SD]: 11 years), and mean time from octreotide LAR initiation to first dose escalation was 1.7 years (SD: 2.0 years). The primary reasons reported for dose escalation were carcinoid or hormonal syndrome (62%) or radiographic progression (28%). The most common dose changes at the first dose escalation were 40 mg every 4 weeks (71%) and 60 mg every 4 weeks (18%). Of 90 patients in whom flushing was reported prior to first dose escalation, 73 (81%) were reported to have experienced improvement or resolution of their symptoms following the dose escalation. Of 107 patients who were reported to have experienced diarrhea before the first dose escalation, 85 (79%) were reported to have experienced improvement or resolution after first dose escalation.
  
  
  CONCLUSIONS
  The goal of improved symptom control is a common reason for dose escalation of octreotide LAR. This study suggests that escalation to above the standard dose of octreotide LAR of 30 mg every 4 weeks may result in improved CS symptom control.
authors.affiliation: Department of Gastrointestinal Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois, USA; Analysis Group, Inc., Boston, Massachusetts, USA; Department of Internal Medicine, University of South Florida, Tampa, Florida, USA; Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Strosberg
authors.affiliation: Department of Gastrointestinal Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois, USA; Analysis Group, Inc., Boston, Massachusetts, USA; Department of Internal Medicine, University of South Florida, Tampa, Florida, USA; Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
authors.forename: Al B
authors.initials: AB
authors.lastname: Benson
authors.affiliation: Department of Gastrointestinal Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois, USA; Analysis Group, Inc., Boston, Massachusetts, USA; Department of Internal Medicine, University of South Florida, Tampa, Florida, USA; Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
authors.forename: Lynn
authors.initials: L
authors.lastname: Huynh
authors.affiliation: Department of Gastrointestinal Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois, USA; Analysis Group, Inc., Boston, Massachusetts, USA; Department of Internal Medicine, University of South Florida, Tampa, Florida, USA; Dana-Farber Cancer Institute, Boston, Massachusetts, USA mduh@analysisgroup.com.
authors.forename: Mei Sheng
authors.initials: MS
authors.lastname: Duh
authors.affiliation: Department of Gastrointestinal Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois, USA; Analysis Group, Inc., Boston, Massachusetts, USA; Department of Internal Medicine, University of South Florida, Tampa, Florida, USA; Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
authors.forename: Jamie
authors.initials: J
authors.lastname: Goldman
authors.affiliation: Department of Gastrointestinal Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois, USA; Analysis Group, Inc., Boston, Massachusetts, USA; Department of Internal Medicine, University of South Florida, Tampa, Florida, USA; Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
authors.forename: Vaibhav
authors.initials: V
authors.lastname: Sahai
authors.affiliation: Department of Gastrointestinal Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois, USA; Analysis Group, Inc., Boston, Massachusetts, USA; Department of Internal Medicine, University of South Florida, Tampa, Florida, USA; Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
authors.forename: Alfred W
authors.initials: AW
authors.lastname: Rademaker
authors.affiliation: Department of Gastrointestinal Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois, USA; Analysis Group, Inc., Boston, Massachusetts, USA; Department of Internal Medicine, University of South Florida, Tampa, Florida, USA; Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Kulke
mesh_terms: D000368:Aged; D003967:Diarrhea / Q000139:chemically induced; D064420:Drug-Related Side Effects and Adverse Reactions / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008303:Malignant Carcinoid Syndrome / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D015282:Octreotide / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D015282:Octreotide
keywords: Above-standard dose; Carcinoid syndrome symptoms; Diarrhea; Flushing; Neuroendocrine tumor; Somatostatin analogs
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