Aerts Maridi, Reynaert Hendrik
University Hospital, UZ Brussel, Department of Gastroenterology and Hepatology, Brussels, Belgium.
Case Rep Gastroenterol. 2017 Dec 6;11(3):616-623. doi: 10.1159/000485025. eCollection 2017 Sep-Dec.
Gastrinomas are functionally active pancreatic neuroendocrine tumors (NETs) secreting gastrin and are associated with local or regional metastases in 60% of the cases. Somatostatin analogs (SSAs) are currently recommended as a first-line treatment for the symptomatic treatment of NETs. Although antiproliferative activity of SSAs has been demonstrated in various cancer types in several in vivo and in vitro studies, clinical benefits with SSAs have been only achieved in a small proportion of patients. We report a disease control on a long-acting SSA lanreotide in a patient with metastatic gastrinoma. A 60-year-old man, who had previously undergone a surgical resection of metastatic pancreatic gastrinoma, presented with abdominal bloating, edema in the lower limbs, fatigue, and weight loss. The gastrinoma relapse with additional metastases in the pancreas, duodenum, and liver was confirmed by positron emission tomography-computed tomography (PET-CT) scan; the patient's blood gastrin level was >5,000 ng/L. Treatment with the SSA octreotide long-acting release was initiated to treat the gastrinoma relapse. On the CT scan done in September 2011, the liver metastases were still identifiable. In December 2011, the treatment was switched to lanreotide Autogel® (120 mg every 2 weeks). Following the treatment, the gastrin levels were reduced to <1,200 ng/L in September 2013, and 812 ng/L in July 2016. Since November 2012, the gastrinoma lesions were no longer visible in abdominal CT. At the time of this report, the patient's gastrinoma was under control with lanreotide Autogel®. This case report supports the use of lanreotide Autogel® as effective treatment for metastatic gastrinoma.
胃泌素瘤是分泌胃泌素的功能性活性胰腺神经内分泌肿瘤（NETs），60%的病例伴有局部或区域转移。生长抑素类似物（SSAs）目前被推荐作为NETs症状性治疗的一线疗法。尽管在多项体内和体外研究中已证实SSAs在多种癌症类型中具有抗增殖活性，但仅一小部分患者从SSAs治疗中获得了临床益处。我们报告了1例转移性胃泌素瘤患者使用长效SSA兰瑞肽实现疾病控制的情况。1名60岁男性，既往曾接受转移性胰腺胃泌素瘤手术切除，现出现腹胀、下肢水肿、乏力和体重减轻。正电子发射断层扫描-计算机断层扫描（PET-CT）证实胃泌素瘤复发并伴有胰腺、十二指肠和肝脏的额外转移；患者血胃泌素水平>5000 ng/L。开始使用长效释放奥曲肽治疗胃泌素瘤复发。在2011年9月进行的CT扫描中，肝脏转移灶仍可识别。2011年12月，治疗改为使用兰瑞肽缓释凝胶（每2周120 mg）。治疗后，胃泌素水平在2013年9月降至<1200 ng/L，在2016年7月降至812 ng/L。自2012年11月起，腹部CT未再发现胃泌素瘤病灶。在本报告发布时，患者的胃泌素瘤通过兰瑞肽缓释凝胶得到控制。本病例报告支持将兰瑞肽缓释凝胶作为转移性胃泌素瘤的有效治疗方法。
