title: Gastrointestinal neuroendocrine tumors treated with high dose octreotide-LAR: a systematic literature review.
abstract: OBJECTIVE
  To review literature on efficacy and safety of octreotide-long-acting repeatable (LAR) used at doses higher than the Food and Drug Administration (FDA)-approved 30 mg/mo for treatment of neuroendocrine tumors (NETs).
  
  
  METHODS
  We searched PubMed and Cochrane Library from 1998-2012, 5 conferences (American Society of Clinical Oncology, Endocrine Society, European Neuroendocrine Tumor Society, European Society for Medical Oncology, North American Neuroendocrine Tumor Society) from 2000-2013 using MeSH and keyterms including neuroendocrine tumors, carcinoid tumor, carcinoma, neuroendocrine, and octreotide. Bibliographies of accepted articles were also searched. Two reviewers reviewed titles, abstracts, and full-length articles. Studies that reported data on efficacy and safety of ≥ 30 mg/mo octreotide-LAR for NETs in human subjects, published in any language were included in the review.
  
  
  RESULTS
  The search identified 1086 publications, of which 238 underwent full-text review (20 were translated into English); 17 were included in the review. Studies varied in designs, subjects, octreotide-LAR regimens, and definition of outcomes. Eleven studies reported use of higher doses to control symptoms and tumor progression, although symptom severity and formal quality-of-life analysis were not quantitatively measured. Ten studies reported efficacy, describing 260 subjects with doses ranging from 40 mg/mo or 30 mg/3 wk up to 120 mg/mo. Eight studies reported expert clinical opinion that supported dose escalation of octreotide-LAR up to 60 mg/mo for symptom control and suggested increased doses may be effective at preventing tumor progression. Eight studies reported safety; there was no evidence of increased toxicity associated with doses of octreotide-LAR > 30 mg/mo.
  
  
  CONCLUSIONS
  As reported in this review, octreotide-LAR at doses > 30 mg/mo is being prescribed for symptom and tumor control in NET patients. Furthermore, expert clinical opinion provided support for escalation of somatostatin analogs for refractory hormonal symptoms.
authors: Michael S Broder, David Beenhouwer, Dasha Cherepanov, Partnership for Health Analytic Research, LLC, Beverly Hills, CA 90212, United States.
authors: Michael S
authors: MS
authors: Broder
authors: Michael S Broder, David Beenhouwer, Dasha Cherepanov, Partnership for Health Analytic Research, LLC, Beverly Hills, CA 90212, United States.
authors: David
authors: D
authors: Beenhouwer
authors: Michael S Broder, David Beenhouwer, Dasha Cherepanov, Partnership for Health Analytic Research, LLC, Beverly Hills, CA 90212, United States.
authors: Jonathan R
authors: JR
authors: Strosberg
authors: Michael S Broder, David Beenhouwer, Dasha Cherepanov, Partnership for Health Analytic Research, LLC, Beverly Hills, CA 90212, United States.
authors: Maureen P
authors: MP
authors: Neary
authors: Michael S Broder, David Beenhouwer, Dasha Cherepanov, Partnership for Health Analytic Research, LLC, Beverly Hills, CA 90212, United States.
authors: Dasha
authors: D
authors: Cherepanov
mesh_terms: D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage* / Q000009:adverse effects; D005770:Gastrointestinal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D018358:Neuroendocrine Tumors / Q000188:drug therapy* / Q000473:pathology; D015282:Octreotide / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D018931:Antineoplastic Agents, Hormonal; D015282:Octreotide
keywords: Abdominal pain; Antineoplastic agents; Carcinoid syndrome; Carcinoid tumor; Carcinoma; Diarrhea; Dose-Response relationship; Drug; Effectiveness; Efficacy; Flushing; Gastrointestinal neoplasms; Hormonal; Literature review; Neuroendocrine; Neuroendocrine tumor; Octreotide; Symptom control; Tumor progression control