Raderer M, Kurtaran A, Scheithauer W, Fiebiger W, Weinlaender G, Oberhuber G
Department of Internal Medicine I, Division of Oncology, University of Vienna, Austria.
Oncology. 2001;60(2):141-5. doi: 10.1159/000055311.
Somatostatin (SST) analogues are cornerstones in the symptomatic management of patients suffering from carcinoid tumors, and antiproliferative activity has also been reported for these agents. The most commonly applied SST analogues are octreotide (OCT) and lanreotide (LAN), which are both available in a slow release formulation. To the current knowledge, both OCT and LAN are thought to be equally effective for the management of various disorders. We report the case of a patient with a disseminated carcinoid, who progressed during dose-intensified treatment with slow-release LAN in combination with interferon-alpha, but developed a pronounced response after treatment was switched to the application of a depot formulation of OCT.
A 46-year-old woman was admitted to our department for the evaluation of persistent flushing, diarrhea and dyspnea. After a diagnosis of metastatic carcinoid had been established, treatment with LAN (30 mg i.m. every 10 days) along with interferon-alpha 3 x 5 MU/week was initiated. In spite of successful blocking of tumoral SST receptors as judged by SST receptor scintigraphy and subjective improvement of symptoms, the patient had progressive disease. As she refused chemotherapy, treatment was switched to a depot formulation of OCT (20 mg i.m. every 4 weeks), resulting both in a disappearance of symptoms as well as tumor regression as seen on CT scanning.
To our knowledge, this is the first case demonstrating both a symptomatic as well as objective response to OCT following progression during therapy with LAN in a patient with a carcinoid tumor. Our results suggest that refractoriness to treatment including a long-acting SST analogue does not automatically imply resistance to a related agent and should alert clinicians to the potential of non-cross-resistance between SST analogues in neuroendocrine malignancies.
生长抑素（SST）类似物是类癌患者症状管理的基石，并且这些药物也具有抗增殖活性。最常用的SST类似物是奥曲肽（OCT）和兰瑞肽（LAN），二者均有缓释制剂。就目前所知，OCT和LAN在治疗各种疾病方面被认为同样有效。我们报告了一例播散性类癌患者的病例，该患者在接受缓释LAN联合α干扰素的剂量强化治疗期间病情进展，但在治疗改为应用OCT长效制剂后出现明显反应。
一名46岁女性因持续性潮红、腹泻和呼吸困难入院接受评估。在确诊为转移性类癌后，开始使用LAN（每10天肌内注射30mg）联合α干扰素（每周3次，每次5MU）进行治疗。尽管通过SST受体闪烁显像判断肿瘤SST受体被成功阻断，且症状有主观改善，但患者仍有疾病进展。由于她拒绝化疗，治疗改为OCT长效制剂（每4周肌内注射20mg），结果症状消失，CT扫描显示肿瘤缩小。
据我们所知，这是首例类癌患者在接受LAN治疗期间病情进展后对OCT出现症状性及客观反应的病例。我们的结果表明，对包括长效SST类似物在内的治疗无反应并不必然意味着对相关药物耐药，这应提醒临床医生注意神经内分泌恶性肿瘤中SST类似物之间存在非交叉耐药的可能性。
