For people with metastatic lung carcinoid tumors, several medicines can help control symptoms and tumor growth.
These drugs are related to somatostatin, a natural hormone that seems to help slow the growth of neuroendocrine cells. They are especially useful in people who have carcinoid syndrome (facial flushing, diarrhea, wheezing, rapid heart rate) and in people whose tumors show up on a somatostatin receptor scintigraphy (SRS) scan.
Octreotide is helpful in treating the symptoms of carcinoid syndrome. Sometimes octreotide can temporarily shrink carcinoid tumors, but it does not cure them.
The original version of octreotide (Sandostatin®) is injected under the skin (subcutaneously) at least twice daily. Some people learn to give this injection themselves at home. A long-acting version of the drug (Sandostatin LAR®) is injected into a muscle once a month by your doctor or nurse. Depending on the severity of symptoms, some people are given injections every day when first starting treatment. Once the doctor finds the correct dose, the longer-acting monthly injection may then be used.
Side effects can include pain or burning at the injection site, stomach cramps, nausea, vomiting, headaches, dizziness, and fatigue.
Lanreotide is a drug similar to octreotide. It is injected under the skin once a month. It may be given by your doctor or nurse, or you may learn how to give the injection at home. Side effects are similar to those of octreotide, although pain at the injection site is less common.
In recent years, anti-cancer drugs that work differently from standard chemotherapy drugs have been developed for some types of cancer. These drugs target specific parts of cancer cells. They are sometimes helpful when chemotherapy is not. They often have different side effects than chemotherapy.
The targeted drug, everolimus (Afinitor®), has been shown to help treat advanced lung carcinoid tumors. It can be used with or without somatostatin drugs, such as octreotide. Common side effects include diarrhea, fatigue, rash, mouth sores and swelling of the legs or arms.
See Targeted Cancer Therapy for more information about this type of drug.
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Fazio N, Granberg D, Grossman A, et al. Everolimus plus octreotide long-acting repeatable in patients with advanced lung neuroendocrine tumors: analysis of the phase 3, randomized, placebo-controlled RADIANT-2 study. Chest. 2013;143:955-62.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Neuroendocrine and Adrenal Tumors. V.2.2018. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/neuroendocrine.pdf on July 11, 2018.
Thomas CF, Jett JR, Strosberg JR. Lung neuroendocrine (carcinoid) tumors: Treatment and prognosis. UpToDate website. https://www.uptodate.com/contents/lung-neuroendocrine-carcinoid-tumors-treatment-and-prognosis. Updated Feb. 6, 2018. Accessed July 17, 2018.
Yao JC, Fazio N, Singh S, et al. Everolimus for the treatment of advanced, non-functional neuroendocrine tumours of the lung or gastrointestinal tract (RADIANT-4): A randomised, placebo-controlled, phase 3 study. Lancet. 2016;387:968-77.
Last Revised: August 28, 2018