Management of Neuroendocrine Tumors: Current and Future Therapies

Kjell E Öberg

Disclosures

Expert Rev Endocrinol Metab. 2011;6(1):49-62. 

In This Article

Escape from Response

Patients with NETs receiving sst2-preferring analogues such as octreotide and lanreotide may experience a loss of response (the 'escape from response' phenomenon) around 6–18 months after the initiation of treatment; this is usually related to increased morbidity and mortality.[48–50] This phenomenon is thought to result from internalization or downregulation of sst2 expression, or upregulation of other sst receptor subtypes.[51,52] It has led to interest in new, multireceptor ligand somatostatin analogues that could be as effective and well tolerated in patients who experience an escape from response. Pasireotide may fulfill this role in the future owing to its high affinity for sst1, 2, 3 and 5 receptors.[36] Preliminary data are promising, with effective control of diarrhea and flushing observed in NETs patients refractory or resistant to octreotide LAR.[53] A Phase III study of pasireotide LAR versus octreotide LAR is ongoing in patients with metastatic carcinoid tumors (GI-NETs) whose disease-related symptoms are inadequately controlled by somatostatin analogues (trial NCT00690430; expected to be completed in the third or fourth quarter of 2010[102]).

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