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Gastrointestinal Carcinoid Tumors Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Treatment Option Overview

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Carcinoid crisis is manifested by profound flushing, extreme blood pressure fluctuations, bronchoconstriction, dysrhythmias, and confusion or stupor lasting hours or days and may be provoked by induction of anesthesia or an invasive radiologic procedure.[18,31] This potentially fatal condition can occur after manipulation of tumor masses (including bedside palpation), administration of chemotherapy, or hepatic arterial embolization.[32] In contrast with the treatment of other causes of acute hypotension, the use of calcium and catecholamines should be avoided in carcinoid crisis because these agents provoke the release of bioactive tumor mediators that may perpetuate or worsen the situation. Plasma infusion and octreotide are used for hemodynamic support. For the most part, the use of somatostatin analogues has replaced other pharmacologic maneuvers in the treatment of crises, and their use has been associated with increased survival rates. Prophylactic use of subcutaneous octreotide or the administration of a depot somatostatin analogue in a timely fashion before any procedures are undertaken is mandatory to prevent the development of a crisis.[1]

Molecular-Targeted Therapies

Various therapies targeting vascular endothelial growth factor (VEGF), platelet-derived growth factor receptor (PDGFR), and mammalian target of rapamycin (mTOR) are in development.[1,33] Therapeutic agents under investigation include the VEGF monoclonal antibody, bevacizumab; VEGF tyrosine kinase inhibitors, sunitinib, vatalanib, and sorafenib; and the mTOR inhibitor, everolimus (RAD001).

General Therapeutic Approaches

As might be expected, therapeutic approaches to GI carcinoids vary according to anatomical location. In 2004, a consensus statement regarding the diagnosis and treatment of GI neuroendocrine tumors (NETs) was published on behalf of the European Neuroendocrine Tumor Society (ENETS),[4] which details site-specific approaches to the treatment of GI carcinoids.

References:

  1. Modlin IM, Latich I, Kidd M, et al.: Therapeutic options for gastrointestinal carcinoids. Clin Gastroenterol Hepatol 4 (5): 526-47, 2006.
  2. Rothmund M, Kisker O: Surgical treatment of carcinoid tumors of the small bowel, appendix, colon and rectum. Digestion 55 (Suppl 3): 86-91, 1994.
  3. Loftus JP, van Heerden JA: Surgical management of gastrointestinal carcinoid tumors. Adv Surg 28: 317-36, 1995.
  4. Plöckinger U, Rindi G, Arnold R, et al.: Guidelines for the diagnosis and treatment of neuroendocrine gastrointestinal tumours. A consensus statement on behalf of the European Neuroendocrine Tumour Society (ENETS). Neuroendocrinology 80 (6): 394-424, 2004.
  5. McEntee GP, Nagorney DM, Kvols LK, et al.: Cytoreductive hepatic surgery for neuroendocrine tumors. Surgery 108 (6): 1091-6, 1990.
  6. Søreide O, Berstad T, Bakka A, et al.: Surgical treatment as a principle in patients with advanced abdominal carcinoid tumors. Surgery 111 (1): 48-54, 1992.
  7. Welin SV, Janson ET, Sundin A, et al.: High-dose treatment with a long-acting somatostatin analogue in patients with advanced midgut carcinoid tumours. Eur J Endocrinol 151 (1): 107-12, 2004.
  8. Bruns C, Weckbecker G, Raulf F, et al.: Molecular pharmacology of somatostatin-receptor subtypes. Ann N Y Acad Sci 733: 138-46, 1994.
  9. Lambert P, Minghini A, Pincus W, et al.: Treatment and prognosis of primary malignant small bowel tumors. Am Surg 62 (9): 709-15, 1996.
  10. Schally AV: Oncological applications of somatostatin analogues. Cancer Res 48 (24 Pt 1): 6977-85, 1988.
  11. Patel YC, Greenwood MT, Panetta R, et al.: The somatostatin receptor family. Life Sci 57 (13): 1249-65, 1995.
  12. Reisine T, Bell GI: Molecular biology of somatostatin receptors. Endocr Rev 16 (4): 427-42, 1995.
  13. Oberg K, Kvols L, Caplin M, et al.: Consensus report on the use of somatostatin analogs for the management of neuroendocrine tumors of the gastroenteropancreatic system. Ann Oncol 15 (6): 966-73, 2004.
  14. Anthony LB, Kang Y, Shyr Y, et al.: Malignant carcinoid syndrome: survival in the octreotide LAR era. [Abstract] J Clin Oncol 23 (Suppl 16): A-4084, 328s, 2005.
  15. Corleto VD, Angeletti S, Schillaci O, et al.: Long-term octreotide treatment of metastatic carcinoid tumor. Ann Oncol 11 (4): 491-3, 2000.
  16. Aparicio T, Ducreux M, Baudin E, et al.: Antitumour activity of somatostatin analogues in progressive metastatic neuroendocrine tumours. Eur J Cancer 37 (8): 1014-9, 2001.
  17. Kölby L, Persson G, Franzén S, et al.: Randomized clinical trial of the effect of interferon alpha on survival in patients with disseminated midgut carcinoid tumours. Br J Surg 90 (6): 687-93, 2003.
  18. Ahlman H, Nilsson O, Wängberg B, et al.: Neuroendocrine insights from the laboratory to the clinic. Am J Surg 172 (1): 61-7, 1996.
  19. Oberg K: Future aspects of somatostatin-receptor-mediated therapy. Neuroendocrinology 80 (Suppl 1): 57-61, 2004.
  20. Lamberts SW, van der Lely AJ, Hofland LJ: New somatostatin analogs: will they fulfil old promises? Eur J Endocrinol 146 (5): 701-5, 2002.
  21. Sahin M, Kartal A, Belviranli M, et al.: Effect of octreotide (Sandostatin 201-995) on bile flow and bile components. Dig Dis Sci 44 (1): 181-5, 1999.
  22. Sarmiento JM, Heywood G, Rubin J, et al.: Surgical treatment of neuroendocrine metastases to the liver: a plea for resection to increase survival. J Am Coll Surg 197 (1): 29-37, 2003.
  23. Nobin A, Månsson B, Lunderquist A: Evaluation of temporary liver dearterialization and embolization in patients with metastatic carcinoid tumour. Acta Oncol 28 (3): 419-24, 1989.
  24. Wängberg B, Westberg G, Tylén U, et al.: Survival of patients with disseminated midgut carcinoid tumors after aggressive tumor reduction. World J Surg 20 (7): 892-9; discussion 899, 1996.
  25. Eriksson BK, Larsson EG, Skogseid BM, et al.: Liver embolizations of patients with malignant neuroendocrine gastrointestinal tumors. Cancer 83 (11): 2293-301, 1998.
  26. Mazzaglia PJ, Berber E, Milas M, et al.: Laparoscopic radiofrequency ablation of neuroendocrine liver metastases: a 10-year experience evaluating predictors of survival. Surgery 142 (1): 10-9, 2007.
  27. Kwekkeboom DJ, Teunissen JJ, Bakker WH, et al.: Radiolabeled somatostatin analog [177Lu-DOTA0,Tyr3]octreotate in patients with endocrine gastroenteropancreatic tumors. J Clin Oncol 23 (12): 2754-62, 2005.
  28. Modlin IM, Shapiro MD, Kidd M: Carcinoid tumors and fibrosis: an association with no explanation. Am J Gastroenterol 99 (12): 2466-78, 2004.
  29. Zuetenhorst JM, Bonfrer JM, Korse CM, et al.: Carcinoid heart disease: the role of urinary 5-hydroxyindoleacetic acid excretion and plasma levels of atrial natriuretic peptide, transforming growth factor-beta and fibroblast growth factor. Cancer 97 (7): 1609-15, 2003.
  30. Akerström G, Hellman P, Hessman O, et al.: Management of midgut carcinoids. J Surg Oncol 89 (3): 161-9, 2005.
  31. Kinney MA, Warner ME, Nagorney DM, et al.: Perianaesthetic risks and outcomes of abdominal surgery for metastatic carcinoid tumours. Br J Anaesth 87 (3): 447-52, 2001.
  32. Kharrat HA, Taubin H: Carcinoid crisis induced by external manipulation of liver metastasis. J Clin Gastroenterol 36 (1): 87-8, 2003.
  33. Yao JC: Neuroendocrine tumors. Molecular targeted therapy for carcinoid and islet-cell carcinoma. Best Pract Res Clin Endocrinol Metab 21 (1): 163-72, 2007.
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WebMD Public Information from the National Cancer Institute

Last Updated: February 25, 2014
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.
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