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Somatostatin Analogs and Interferon in the Treatment of Neuroendocrine Tumors

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Neuroendocrine Tumours
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Abstract

Biotherapy for neuroendocrine tumors (NET) emerged in the 1980s when somatostatin analogs (SSAs) and interferons (IFNs) were investigated in small series of patients with malignant carcinoid syndrome. While early clinical trials focused on palliation of hormonal symptoms, subsequent studies have been designed to assess the inhibitory effects of SSAs and IFNs on tumor progression. The recognition that biological therapies may be synergistic has led to several randomized studies investigating IFNα in combination with SSAs. This chapter will review the mechanism of action and key clinical trials investigating SSAs and IFNs in advanced, well-differentiated NETs.

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References

  1. Reichlin S (1983) Somatostatin. N Engl J Med 309(24):1495–1501

    Article  CAS  PubMed  Google Scholar 

  2. Brazeau P et al (1973) Hypothalamic polypeptide that inhibits the secretion of immunoreactive pituitary growth hormone. Science 179(68):77–79

    Article  CAS  PubMed  Google Scholar 

  3. Evers BM et al (1991) Somatostatin and analogues in the treatment of cancer. A review. Ann Surg 213(3):190–198

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  4. Maurer R, Reubi JC (1985) Somatostatin receptors. JAMA 253(18):2741

    Article  CAS  PubMed  Google Scholar 

  5. Lamberts SW et al (1996) Octreotide. N Engl J Med 334(4):246–254

    Article  CAS  PubMed  Google Scholar 

  6. Weckbecker G et al (2003) Opportunities in somatostatin research: biological, chemical and therapeutic aspects. Nat Rev Drug Discov 2(12):999–1017

    Article  CAS  PubMed  Google Scholar 

  7. Bousquet C et al (2001) Antiproliferative effect of somatostatin and analogs. Chemotherapy 47(Suppl 2):30–39

    Article  CAS  PubMed  Google Scholar 

  8. Bauer W et al (1982) SMS 201-995: a very potent and selective octapeptide analogue of somatostatin with prolonged action. Life Sci 31(11):1133–1140

    Article  CAS  PubMed  Google Scholar 

  9. Strosberg J, Kvols L (2010) Antiproliferative effect of somatostatin analogs in gastroenteropancreatic neuroendocrine tumors. World J Gastroenterol 16(24):2963–2970

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  10. Shah T, Caplin M (2005) Endocrine tumours of the gastrointestinal tract. Biotherapy for metastatic endocrine tumours. Best Pract Res Clin Gastroenterol 19(4):617–636

    Article  CAS  PubMed  Google Scholar 

  11. Ducreux M et al (2000) The antitumoral effect of the long-acting somatostatin analog lanreotide in neuroendocrine tumors. Am J Gastroenterol 95(11):3276–3281

    Article  CAS  PubMed  Google Scholar 

  12. Kvols LK et al (1986) Treatment of the malignant carcinoid syndrome. Evaluation of a long-acting somatostatin analogue. N Engl J Med 315(11):663–666

    Article  CAS  PubMed  Google Scholar 

  13. O'Toole D et al (2000) Treatment of carcinoid syndrome: a prospective crossover evaluation of lanreotide versus octreotide in terms of efficacy, patient acceptability, and tolerance. Cancer 88(4):770–776

    Article  PubMed  Google Scholar 

  14. di Bartolomeo M et al (1996) Clinical efficacy of octreotide in the treatment of metastatic neuroendocrine tumors. A study by the Italian Trials in Medical Oncology Group. Cancer 77(2):402–408

    Article  PubMed  Google Scholar 

  15. Oberg K et al (2004) Consensus report on the use of somatostatin analogs for the management of neuroendocrine tumors of the gastroenteropancreatic system. Ann Oncol 15(6):966–973

    Article  CAS  PubMed  Google Scholar 

  16. Maton PN (1993) Use of octreotide acetate for control of symptoms in patients with islet cell tumors. World J Surg 17(4):504–510

    Article  CAS  PubMed  Google Scholar 

  17. Wymenga AN et al (1999) Efficacy and safety of prolonged-release lanreotide in patients with gastrointestinal neuroendocrine tumors and hormone-related symptoms. J Clin Oncol 17(4):1111

    CAS  PubMed  Google Scholar 

  18. Kvols LK et al (1987) Treatment of metastatic islet cell carcinoma with a somatostatin analogue (SMS 201-995). Ann Intern Med 107(2):162–168

    Article  CAS  PubMed  Google Scholar 

  19. O'Dorisio TM et al (1988) Somatostatin and analogues in the treatment of VIPoma. Ann N Y Acad Sci 527:528–535

    Article  PubMed  Google Scholar 

  20. Boden G et al (1986) Treatment of inoperable glucagonoma with the long-acting somatostatin analogue SMS 201-995. N Engl J Med 314(26):1686–1689

    Article  CAS  PubMed  Google Scholar 

  21. Usukura M et al (2007) Medical treatment of benign insulinoma using octreotide LAR: a case report. Endocr J 54(1):95–101

    Article  CAS  PubMed  Google Scholar 

  22. Healy ML et al (2007) Severe hypoglycaemia after long-acting octreotide in a patient with an unrecognized malignant insulinoma. Intern Med J 37(6):406–409

    Article  CAS  PubMed  Google Scholar 

  23. Rubin J et al (1999) Octreotide acetate long-acting formulation versus open-label subcutaneous octreotide acetate in malignant carcinoid syndrome. J Clin Oncol 17(2):600–606

    CAS  PubMed  Google Scholar 

  24. Sandostatin (octreotide acetate) injections prescribing information (PI). Novartis Pharmaceuticals Corp. http://www.pharma.us.novartis.com/product/pi/pdf/sandostatin_lar.pdf

  25. Eriksson B et al (2008) Consensus guidelines for the management of patients with digestive neuroendocrine tumors–well-differentiated jejunal-ileal tumor/carcinoma. Neuroendocrinology 87(1):8–19

    Article  CAS  PubMed  Google Scholar 

  26. Rinke A et al (2009) Placebo-controlled, double-blind, prospective, randomized study on the effect of octreotide LAR in the control of tumor growth in patients with metastatic neuroendocrine midgut tumors: a report from the PROMID Study Group. J Clin Oncol 27(28):4656–4663

    Article  CAS  PubMed  Google Scholar 

  27. Kvols LK et al (1985) Rapid reversal of carcinoid crisis with a somatostatin analogue. N Engl J Med 313(19):1229–1230

    CAS  PubMed  Google Scholar 

  28. Caplin ME et al (1998) Carcinoid tumour. Lancet 352(9130):799–805

    Article  CAS  PubMed  Google Scholar 

  29. Grozinsky-Glasberg S et al (2008) Somatostatin analogues in the control of neuroendocrine tumours: efficacy and mechanisms. Endocr Relat Cancer 15(3):701–720

    Article  CAS  PubMed  Google Scholar 

  30. Sharma K, Srikant CB (1998) G protein coupled receptor signaled apoptosis is associated with activation of a cation insensitive acidic endonuclease and intracellular acidification. Biochem Biophys Res Commun 242(1):134–140

    Article  CAS  PubMed  Google Scholar 

  31. Lattuada D et al (2002) The apoptotic effect of somatostatin analogue SMS 201-995 on human lymphocytes. J Neuroimmunol 133(1–2):211–216

    Article  CAS  PubMed  Google Scholar 

  32. Serri O et al (1992) Octreotide inhibits insulin-like growth factor-I hepatic gene expression in the hypophysectomized rat: evidence for a direct and indirect mechanism of action. Endocrinology 130(4):1816–1821

    CAS  PubMed  Google Scholar 

  33. Florio T et al (2003) Somatostatin inhibits tumor angiogenesis and growth via somatostatin receptor-3-mediated regulation of endothelial nitric oxide synthase and mitogen-activated protein kinase activities. Endocrinology 144(4):1574–1584

    Article  CAS  PubMed  Google Scholar 

  34. Zapata PD et al (2002) Autocrine regulation of human prostate carcinoma cell proliferation by somatostatin through the modulation of the SH2 domain containing protein tyrosine phosphatase (SHP)-1. J Clin Endocrinol Metab 87(2):915–926

    Article  CAS  PubMed  Google Scholar 

  35. Thangaraju M et al (1999) Interdependent regulation of intracellular acidification and SHP-1 in apoptosis. Cancer Res 59(7):1649–1654

    CAS  PubMed  Google Scholar 

  36. Theodoropoulou M et al (2006) Octreotide, a somatostatin analogue, mediates its antiproliferative action in pituitary tumor cells by altering phosphatidylinositol 3-kinase signaling and inducing Zac1 expression. Cancer Res 66(3):1576–1582

    Article  CAS  PubMed  Google Scholar 

  37. Sharma K, Patel YC, Srikant CB (1996) Subtype-selective induction of wild-type p53 and apoptosis, but not cell cycle arrest, by human somatostatin receptor 3. Mol Endocrinol 10(12):1688–1696

    CAS  PubMed  Google Scholar 

  38. Massa A et al (2004) The phosphotyrosine phosphatase eta mediates somatostatin inhibition of glioma proliferation via the dephosphorylation of ERK1/2. Ann N Y Acad Sci 1030:264–274

    Article  CAS  PubMed  Google Scholar 

  39. Florio T et al (1999) Somatostatin activation of mitogen-activated protein kinase via somatostatin receptor 1 (SSTR1). Mol Endocrinol 13(1):24–37

    Article  CAS  PubMed  Google Scholar 

  40. Koch BD, Schonbrunn A (1984) The somatostatin receptor is directly coupled to adenylate cyclase in GH4C1 pituitary cell membranes. Endocrinology 114(5):1784–1790

    Article  CAS  PubMed  Google Scholar 

  41. Schettini G et al (1988) Somatostatin inhibition of anterior pituitary adenylate cyclase activity: different sensitivity between male and female rats. Brain Res 439(1–2):322–329

    Article  CAS  PubMed  Google Scholar 

  42. Ambler GR et al (1996) The effects of octreotide on GH receptor and IGF-I expression in the GH-deficient rat. J Endocrinol 149(2):223–231

    Article  CAS  PubMed  Google Scholar 

  43. Woltering EA et al (1997) Somatostatin analogs: angiogenesis inhibitors with novel mechanisms of action. Invest New Drugs 15(1):77–86

    Article  CAS  PubMed  Google Scholar 

  44. Adams RL et al (2005) Somatostatin receptors 2 and 5 are preferentially expressed in proliferating endothelium. Br J Cancer 92(8):1493–1498

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  45. Arena S et al (2005) Somatostatin receptor subtype-dependent regulation of nitric oxide release: involvement of different intracellular pathways. Mol Endocrinol 19(1):255–267

    Article  CAS  PubMed  Google Scholar 

  46. Kumar M et al (2004) Antiangiogenic effect of somatostatin receptor subtype 2 on pancreatic cancer cell line: Inhibition of vascular endothelial growth factor and matrix metalloproteinase-2 expression in vitro. World J Gastroenterol 10(3):393–399

    CAS  PubMed  Google Scholar 

  47. Aparicio T et al (2001) Antitumour activity of somatostatin analogues in progressive metastatic neuroendocrine tumours. Eur J Cancer 37(8):1014–1019

    Article  CAS  PubMed  Google Scholar 

  48. Arnold R et al (1993) Somatostatin analog sandostatin and inhibition of tumor growth in patients with metastatic endocrine gastroenteropancreatic tumors. World J Surg 17(4):511–519

    Article  CAS  PubMed  Google Scholar 

  49. Saltz L et al (1993) Octreotide as an antineoplastic agent in the treatment of functional and nonfunctional neuroendocrine tumors. Cancer 72(1):244–248

    Article  CAS  PubMed  Google Scholar 

  50. Eriksson B et al (1997) High-dose treatment with lanreotide of patients with advanced neuroendocrine gastrointestinal tumors: clinical and biological effects. Ann Oncol 8(10):1041–1044

    Article  CAS  PubMed  Google Scholar 

  51. Arnold R et al (1996) Somatostatin analogue octreotide and inhibition of tumour growth in metastatic endocrine gastroenteropancreatic tumours. Gut 38(3):430–438

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  52. Panzuto F et al (2005) Prognostic factors and survival in endocrine tumor patients: comparison between gastrointestinal and pancreatic localization. Endocr Relat Cancer 12(4):1083–1092

    Article  PubMed  Google Scholar 

  53. Study of Lanreotide Autogel in non-functioning entero-pancreatic endocrine tumours (2006) ClinicalTrials.gov Identifier: NCT00326469

    Google Scholar 

  54. Strosberg J et al (2013) Dosing patterns for Octreotide LAR in Neuroendocrine Tumor Patients. In: Meeting of the American Society of Clinical Oncology, Chicago

    Google Scholar 

  55. Strosberg J et al (2013) Above-label doses of octreotide-lar in patients with metastatic small intestinal carcinoid tumors. Gastrointest Cancer Res. 6(3):81–5

    Google Scholar 

  56. Ferolla P et al (2012) Shortened interval of long-acting octreotide administration is effective in patients with well-differentiated neuroendocrine carcinomas in progression on standard doses. J Endocrinol Invest 35(3):326–331

    CAS  PubMed  Google Scholar 

  57. Schmid HA (2008) Pasireotide (SOM230): development, mechanism of action and potential applications. Mol Cell Endocrinol 286(1–2):69–74

    Article  CAS  PubMed  Google Scholar 

  58. Kvols LK et al (2012) Pasireotide (SOM230) shows efficacy and tolerability in the treatment of patients with advanced neuroendocrine tumors refractory or resistant to octreotide LAR: results from a phase II study. Endocr Relat Cancer 19(5):657–666

    Article  CAS  PubMed  Google Scholar 

  59. Wolin E et al (2013) A multicenter, randomized, blinded, phase III study of pasireotide LAR versus octreotide LAR in patients with metastatic neuroendocrine tumors with disease-related symptoms inadequately controlled by somatostatin analogs. J Clin Oncol (31):suppl; abstr4031

    Google Scholar 

  60. Oberg K, Funa K, Alm G (1983) Effects of leukocyte interferon on clinical symptoms and hormone levels in patients with mid-gut carcinoid tumors and carcinoid syndrome. N Engl J Med 309(3):129–133

    Article  CAS  PubMed  Google Scholar 

  61. Biesma B et al (1992) Recombinant interferon alpha-2b in patients with metastatic apudomas: effect on tumours and tumour markers. Br J Cancer 66(5):850–855

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  62. Schober C et al (1992) Antitumour effect and symptomatic control with interferon alpha 2b in patients with endocrine active tumours. Eur J Cancer 28A(10):1664–1666

    Article  CAS  PubMed  Google Scholar 

  63. Pestka S et al (1987) Interferons and their actions. Annu Rev Biochem 56:727–777

    Article  CAS  PubMed  Google Scholar 

  64. Platanias LC (2005) Mechanisms of type-I- and type-II-interferon-mediated signalling. Nat Rev Immunol 5(5):375–386

    Article  CAS  PubMed  Google Scholar 

  65. Ferrantini M, Capone I, Belardelli F (2007) Interferon-alpha and cancer: mechanisms of action and new perspectives of clinical use. Biochimie 89(6–7):884–893

    Article  CAS  PubMed  Google Scholar 

  66. von Marschall Z et al (2003) Effects of interferon alpha on vascular endothelial growth factor gene transcription and tumor angiogenesis. J Natl Cancer Inst 95(6):437–448

    Article  Google Scholar 

  67. Sangfelt O et al (1999) Molecular mechanisms underlying interferon-alpha-induced G0/G1 arrest: CKI-mediated regulation of G1 Cdk-complexes and activation of pocket proteins. Oncogene 18(18):2798–2810

    Article  CAS  PubMed  Google Scholar 

  68. Rosewicz S et al (2004) Interferon-alpha: regulatory effects on cell cycle and angiogenesis. Neuroendocrinology 80(Suppl 1):85–93

    Article  CAS  PubMed  Google Scholar 

  69. Thyrell L et al (2002) Mechanisms of Interferon-alpha induced apoptosis in malignant cells. Oncogene 21(8):1251–1262

    Article  CAS  PubMed  Google Scholar 

  70. Oberg K et al (1986) Treatment of malignant carcinoid tumors with human leukocyte interferon: long-term results. Cancer Treat Rep 70(11):1297–1304

    CAS  PubMed  Google Scholar 

  71. Eriksson B et al (1986) Treatment of malignant endocrine pancreatic tumours with human leucocyte interferon. Lancet 2(8519):1307–1309

    Article  CAS  PubMed  Google Scholar 

  72. Bajetta E et al (1993) Treatment of metastatic carcinoids and other neuroendocrine tumors with recombinant interferon-alpha-2a. A study by the Italian Trials in Medical Oncology Group. Cancer 72(10):3099–3105

    Article  CAS  PubMed  Google Scholar 

  73. Moertel CG, Rubin J, Kvols LK (1989) Therapy of metastatic carcinoid tumor and the malignant carcinoid syndrome with recombinant leukocyte A interferon. J Clin Oncol 7(7):865–868

    CAS  PubMed  Google Scholar 

  74. Janson ET, Oberg K (1993) Long-term management of the carcinoid syndrome. Treatment with octreotide alone and in combination with alpha-interferon. Acta Oncol 32(2):225–229

    Article  CAS  PubMed  Google Scholar 

  75. Frank M et al (1999) Combination therapy with octreotide and alpha-interferon: effect on tumor growth in metastatic endocrine gastroenteropancreatic tumors. Am J Gastroenterol 94(5):1381–1387

    CAS  PubMed  Google Scholar 

  76. Pavel ME et al (2006) Efficacy and tolerability of pegylated IFN-alpha in patients with neuroendocrine gastroenteropancreatic carcinomas. J Interferon Cytokine Res 26(1):8–13

    Article  CAS  PubMed  Google Scholar 

  77. Kolby L et al (2003) Randomized clinical trial of the effect of interferon alpha on survival in patients with disseminated midgut carcinoid tumours. Br J Surg 90(6):687–693

    Article  CAS  PubMed  Google Scholar 

  78. Arnold R et al (2005) Octreotide versus octreotide plus interferon-alpha in endocrine gastroenteropancreatic tumors: a randomized trial. Clin Gastroenterol Hepatol 3(8):761–771

    Article  CAS  PubMed  Google Scholar 

  79. Faiss S et al (2003) Prospective, randomized, multicenter trial on the antiproliferative effect of lanreotide, interferon alfa, and their combination for therapy of metastatic neuroendocrine gastroenteropancreatic tumor--he International Lanreotide and Interferon Alfa Study Group. J Clin Oncol 21(14):2689–2696

    Google Scholar 

  80. Oberg K (2000) Interferon in the management of neuroendocrine GEP-tumors: a review. Digestion 62(Suppl 1):92–97

    CAS  PubMed  Google Scholar 

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Strosberg, J. (2015). Somatostatin Analogs and Interferon in the Treatment of Neuroendocrine Tumors. In: Yalcin, S., Öberg, K. (eds) Neuroendocrine Tumours. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-45215-8_30

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