title: Retrospective review of serotonergic medication tolerability in patients with neuroendocrine tumors with biochemically proven carcinoid syndrome.
abstract: BACKGROUND
  Patients with carcinoid tumors frequently could benefit from the pharmacologic treatment of depression and anxiety. However, many prescribers avoid serotonergic medications due to the theoretical risk of exacerbating carcinoid syndrome.
  
  
  METHODS
  The authors conducted a retrospective chart review of patients with carcinoid tumors and elevated serotonin levels (as measured by 24-hour urine 5-hydroxyindoleacetic acid [5-HIAA]) at Dana-Farber/Brigham and Women's Cancer Center who initiated treatment with serotonergic antidepressants after a carcinoid diagnosis from 2003 to 2016. Each medication regimen was categorized based on the presence of adverse interactions as defined by clinical worsening of symptoms of carcinoid syndrome in the absence of progressive disease that temporally correlated with a serotonergic medication trial.
  
  
  RESULTS
  A total of 73 serotonergic regimens received by 52 patients were included in the primary analysis. Among these medication trials, 8.2% of the regimens (6 regimens) were categorized as being associated with a likely adverse interaction, 61.6% of the regimens (45 regimens) were categorized as having no adverse reaction, 9.6% of the regimens (7 regimens) were categorized as an unlikely adverse reaction, and 20.6% of the regimens (15 regimens) were categorized as unknown. It is interesting to note that none of the 73 trials resulted in a carcinoid crisis requiring emergency care or hospitalization. Only 3 patients discontinued serotonergic medications due to worsening carcinoid syndrome.
  
  
  CONCLUSIONS
  Serotonergic medications appear to be a safe option for the treatment of depressive and anxiety symptoms in the majority of patients with neuroendocrine tumors and carcinoid syndrome. In the current study, <10% of patients developed a combination of flushing, diarrhea, and bloating after the initiation of serotonergic medications. Clinicians can begin with low doses, monitor these symptoms, and reduce the dose or discontinue the medication if necessary. Cancer 2017;123:2735-42. © 2017 American Cancer Society.
authors.affiliation: Harvard Medical School, Boston, Massachusetts.
authors.forename: Diana D
authors.initials: DD
authors.lastname: Shi
authors.affiliation: Harvard Medical School, Boston, Massachusetts.|Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.|Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: David P
authors.initials: DP
authors.lastname: Yuppa
authors.affiliation: Center for Gastrointestinal Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Trevor
authors.initials: T
authors.lastname: Dutton
authors.affiliation: Center for Gastrointestinal Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Lauren K
authors.initials: LK
authors.lastname: Brais
authors.affiliation: Harvard Medical School, Boston, Massachusetts.|Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Minden
authors.affiliation: Harvard Medical School, Boston, Massachusetts.|Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.|Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Ilana M
authors.initials: IM
authors.lastname: Braun
authors.affiliation: Harvard Medical School, Boston, Massachusetts.|Center for Gastrointestinal Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Kulke
authors.affiliation: Harvard Medical School, Boston, Massachusetts.|Center for Gastrointestinal Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Chan
authors.affiliation: Harvard Medical School, Boston, Massachusetts.|Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.|Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Fremonta L
authors.initials: FL
authors.lastname: Meyer
mesh_terms: D001007:Anxiety / Q000150:complications / Q000188:drug therapy*; D002276:Carcinoid Tumor / Q000150:complications / Q000378:metabolism; D003863:Depression / Q000150:complications / Q000188:drug therapy*; D003967:Diarrhea / Q000139:chemically induced / Q000209:etiology; D005260:Female; D005483:Flushing / Q000139:chemically induced / Q000209:etiology; D006801:Humans; D006897:Hydroxyindoleacetic Acid / Q000652:urine; D008297:Male; D008303:Malignant Carcinoid Syndrome / Q000150:complications / Q000378:metabolism*; D012189:Retrospective Studies; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*
chemical_list: D006897:Hydroxyindoleacetic Acid; D017367:Selective Serotonin Reuptake Inhibitors
keywords: anxiety; carcinoid syndrome; carcinoid tumor; depression; neuroendocrine tumor; selective serotonin reuptake inhibitor (SSRI); serotonergic medication