Strosberg Jonathan, Weber Jill, Feldman Max, Goldman Jamie, Almhanna Khaldoun, Kvols Larry
Department of GI Oncology Moffitt Cancer Center and Research Institute Tampa, FL.
Gastrointest Cancer Res. 2013 May;6(3):81-5.
Octreotide LAR is indicated for treatment of malignant carcinoid syndrome and has been studied at doses of 10 to 30 mg intramuscularly every 4 weeks. In clinical practice, higher doses are often prescribed for patients who experience refractory carcinoid syndrome (flushing and/or diarrhea) or tumor growth while on the maximum label-recommended dose.
We performed a retrospective, longitudinal review of octreotide LAR administration at a tertiary institution to determine the frequency of above-label dosing and outcomes.
Three hundred thirty-eight patients were considered evaluable, among whom 100 (30%) underwent at least 1 increase in dose or frequency of octreotide-LAR above the standard label dose. The most common maximum doses were 40 mg every 4 weeks (n = 37 patients), 60 mg every 4 weeks (n = 34), and 30 mg every 3 weeks (n = 18). The indications for dose increase were worsening carcinoid syndrome (n = 60), radiographic progression (n = 33), and rising urine 5-HIAA (n = 6). Of the patients whose doses were increased for refractory carcinoid syndrome, 62% (n = 34) experienced improvement in diarrhea, and 56% (n = 28) experienced improvement in flushing.
In conclusion, octreotide LAR is commonly prescribed in doses or schedules above the recommended dose and frequency. Patients with refractory carcinoid syndrome appear to experience a clinical benefit from this change. Prospective data may be used to further evaluate this strategy.
长效奥曲肽适用于治疗恶性类癌综合征，已针对每4周肌肉注射10至30毫克的剂量进行了研究。在临床实践中，对于在最大标签推荐剂量下仍出现难治性类癌综合征（潮红和/或腹泻）或肿瘤生长的患者，通常会开具更高剂量的药物。
我们对一家三级医疗机构的长效奥曲肽给药情况进行了回顾性纵向研究，以确定超量给药的频率和结果。
338例患者被认为可评估，其中100例（30%）至少有1次长效奥曲肽的剂量或给药频率增加至超过标准标签剂量。最常见的最大剂量为每4周40毫克（37例患者）、每4周60毫克（34例）和每3周30毫克（18例）。增加剂量的指征为类癌综合征恶化（60例）、影像学进展（33例）和尿5-羟吲哚乙酸升高（6例）。在因难治性类癌综合征而增加剂量的患者中，62%（34例）腹泻有所改善，56%（28例）潮红有所改善。
总之，长效奥曲肽通常以高于推荐剂量和频率的剂量或给药方案开具。难治性类癌综合征患者似乎从这种改变中获得了临床益处。前瞻性数据可用于进一步评估这一策略。
