a Department of Medical Oncology , European Neuroendocrine Tumour Society (ENETS) Centre of Excellence, The Christie NHS Foundation Trust , Manchester , UK.
b Division of Cancer Sciences , University of Manchester , Manchester , UK.
Expert Rev Gastroenterol Hepatol. 2018 Jul;12(7):723-731. doi: 10.1080/17474124.2018.1489232. Epub 2018 Jun 28.
Patients with advanced well-differentiated neuroendocrine tumours (Wd-NETs) are commonly treated with somatostatin analogues (SSAs). Some patients may develop SSA-related side effects such as pancreatic exocrine insufficiency (PEI).
In this prospective, observational study, the frequency of SSA-induced PEI in 50 sequential patients with advanced Wd-NETs treated with SSAs was investigated. Toxicity was assessed monthly and faecal elastase-1 (FE1) and quality of life (QoL) were assessed 3-monthly.
The median age was 65.8 years, 58% were male and the majority (92%) of patients had metastatic disease; patients received 4-weekly long acting octreotide (60%) or lanreotide (40%). Twelve patients (24%) developed SSA-related PEI after a median of 2.9 months from SSA initiation; FE1 was a reliable screening tool for PEI, especially in symptomatic (abdominal bloating, flatulence and/or diarrhea) patients (risk ratio 8.25 (95% confidence interval 1.15-59.01)). Most of these patients (11/12; 92%) required PERT. Other SSA-related adverse events (any grade) included flatulence (50%), abdominal pain (32%), diarrhoea (30%) and fatigue (20%). Development of PEI did not significantly worsen overall QoL, however gastrointestinal symptoms and diarrhoea were increased.
This study demonstrated that PEI occurs at a higher rate than previously reported; clinicians need to diagnose and treat this SSA-related adverse-event which occurs in 1 in 4 patients with Wd-NETs treated with SSAs. Screening with FE1 in symtomatic patients is recommend.
晚期分化良好的神经内分泌肿瘤（Wd-NETs）患者通常采用生长抑素类似物（SSAs）进行治疗。一些患者可能会出现 SSA 相关的副作用，如胰腺外分泌功能不全（PEI）。
在这项前瞻性观察研究中，调查了 50 例接受 SSAs 治疗的晚期 Wd-NETs 患者中 SSA 诱导的 PEI 的频率。每月评估毒性，每 3 个月评估粪便弹性蛋白酶-1（FE1）和生活质量（QoL）。
中位年龄为 65.8 岁，58%为男性，大多数（92%）患者患有转移性疾病；患者接受了 4 周一次的长效奥曲肽（60%）或兰瑞肽（40%）治疗。12 名患者（24%）在开始使用 SSA 后中位 2.9 个月出现 SSA 相关的 PEI；FE1 是筛查 PEI 的可靠工具，尤其是在有症状（腹胀、气胀和/或腹泻）的患者中（风险比 8.25（95%置信区间 1.15-59.01））。这些患者中的大多数（11/12；92%）需要 PERT。其他 SSA 相关的不良反应（任何等级）包括气胀（50%）、腹痛（32%）、腹泻（30%）和疲劳（20%）。PEI 的发生并未显著恶化整体 QoL，但胃肠道症状和腹泻增加。
本研究表明，PEI 的发生率高于先前报道；临床医生需要诊断和治疗接受 SSAs 治疗的 Wd-NETs 患者中每 4 例中就有 1 例发生的这种 SSA 相关不良事件。建议对有症状的患者进行 FE1 筛查。
