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18-09-2017 | Neuroendocrine tumors | Review | Article

Optimizing Somatostatin Analog Use in Well or Moderately Differentiated Gastroenteropancreatic Neuroendocrine Tumors

Journal:
Current Oncology Reports

Authors: Alberto Carmona-Bayonas, Paula Jiménez-Fonseca, Ana Custodio, Enrique Grande, Jaume Capdevila, Carlos López, Alex Teule, Rocío Garcia-Carbonero, On behalf of the Spanish Neuroendocrine Tumor Group (GETNE)

Publisher: Springer US

Abstract

Somatostatin analogues, aiming to control tumor secretion or growth, constitute the most attractive therapeutic option for patients with well-differentiated gastroenteropancreatic neuroendocrine tumors (GEP-NETs). The objective of this article is to provide a comprehensive review of the current state-of-the-art knowledge gaps and potential opportunities for future development and optimization of this therapeutic modality.
A contextualized systematic review with a narrative component was conducted using PubMed, The Cochrane Library, EMBASE, and Google Scholar. Titles were screened, and non-English, duplicate, or irrelevant entries were excluded. Selection criteria for articles included the following: publication in English between 1995 and 2016, patients with GEP-NETs, analysis of efficacy, safety, practical management considerations, predictive factors, and/or strategies for overcoming resistance, concerning somatostatin analogs.
Ninety-seven studies out of 2771 screened publications met the inclusion criteria (16 randomized clinical trials, 27 phase II trials, 3 phase I trials, 3 subgroup analyses of clinical trials, 1 open-label extension of a randomized trial, 1 phase IV trial, 32 observational studies, and 14 basic research articles). The nature and scope of literature was diverse with most articles dedicated to drug efficacy or indications of use ( n = 49), pharmacological issues ( n = 8), assessment or predictors of response ( n = 4), practical management ( n = 11), combination therapy or other means to overcome resistance ( n = 19), receptors and signaling pathways ( n = 3), and subgroup analyses ( n = 3).
In this appraisal, we have found some practical aspects that can help to the optimization of somatostatin analog (SSA) therapy in patients with well-differentiated GEP-NETs. We have also identified areas of uncertainty in an effort to guide clinical research in the coming years.

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