High-Dose Somatostatin Analogs for the Treatment of Neuroendocrine Neoplasms: where are we Now?

Opinion statement Neuroendocrine tumors (NET) represent a complex and heterogeneous group of malignancies arising from the diffuse endocrine cells and other cells derived from the neural crest. Advanced disease is observed at diagnosis in more than one-third of patients. Somatostatin analogs (SSA) are the cornerstone in advanced well-differentiated NET treatment. Unfortunately, most patients will eventually develop resistance to SSA treatment by different mechanisms that are not fully understood. In some cases of refractory carcinoid syndrome or progressive disease, the increase of SSA dose may help to reach out a symptomatic and/or tumor growth control. The clinical evidence behind above-label SSA administration is limited and should be individualized and discussed patient by patient. Some questions regarding high-dose SSA use are unsolved, such as the optimal dose to use, the frequency of administration, or the need of deepen molecular understanding that could help to adequately select patients for this approach.

Automated summary

Neuroendocrine tumors (NET) are a complex and heterogeneous group of malignancies, with over one-third of patients diagnosed at an advanced stage. Somatostatin analogs (SSA) are the cornerstone in treating advanced well-differentiated NET, but many patients eventually develop resistance to this treatment. Increasing the SSA dose may help control symptoms and tumor growth in some cases, but there are still unanswered questions about the optimal dose, frequency, and patient selection for high-dose SSA use.