Carcinoid Syndrome Treatment When PRRT with 177Lutetium-DOTATATE Has Not Achieved Adequate Symptom Control
This protocol applies to patients with carcinoid syndrome in whom peptide receptor radionuclide therapy (PRRT) with 177Lutetium-DOTATATE — administered in patients with positive somatostatin-receptor imaging, alongside continued somatostatin analogue therapy — did not achieve the expected response.
Previous line — failure condition
Prior therapy: Peptide receptor radionuclide therapy (PRRT) with 177Lutetium-DOTATATE, with somatostatin analogue (SSA) continued throughout.
- Insufficient decrease in diarrhoea, pain, fatigue, and flushing
- Less than 30% decrease in urinary 5-HIAA (u5-HIAA)
Next-line approach — partial overview
After PRRT failure, the protocol moves to systemic agents continued alongside somatostatin analogue therapy throughout. More than one agent class is considered, with selection guided by individual patient factors.
Specific agents, eligibility criteria, sequencing, and full administration details are in the complete protocol below.
Treatment goal
Symptom relief of carcinoid syndrome.
References
DOI: 10.1111/jne.13146
- A small series demonstrated that everolimus combined with octreotide LAR led to symptom relief in RCS.
- Despite its low evidence as an anti-secretory agent, everolimus has proven antitumour activity in NET and can be considered in RCS patients.
- The anti-secretory effects of interferon alpha (IFN-α) may be useful in RCS patients.
- The recommended dose of IFN-α is 3–9 MU s.c. every other day. A slow-release formulation of 50–100 μg PEGylated IFN-α is given s.c. once a week.
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