Zentralbl Chir 2001; 126(9): 682-685
DOI: 10.1055/s-2001-18240
Endokrine Chirurgie

J.A.Barth Verlag in Medizinverlage Heidelberg GmbH & Co.KG

Medikamentöse Therapie bei Karzinoiden des Gastrointestinaltraktes

Drug therapy in carcinoid tumors of the gastrointestinal tractM. Engelbach1 , C. P. Heusel2 , J. Kriegsmann3 , S. Both4 , S. Walgenbach5
  • 1Klinik und Poliklinik Innere Medizin, Schwerpunkt Endokrinologie und Stoffwechselerkrankungen (Direktor: Prof. Dr. Beyer),
  • 2Klinik und Poliklinik für Radiologie (Direktor: Prof. Dr. Thelen),
  • 3Institut für Pathologie (Direktor: Prof. Dr. Kirkpatrick),
  • 4Klinik und Poliklinik für Nuklearmedizin (Direktor: Prof. Dr. Bartenstein) und
  • 5Klinik und Poliklinik für Allgemein- und Abdominalchirurgie (Direktor: Prof. Dr. Junginger) Johannes-Gutenberg-Universität, Mainz
Further Information

Publication History

Publication Date:
06 November 2001 (online)

Drug therapy in carcinoid tumors of the gastrointestinal tract

Summary

Carcinoid tumors are rare and slowly growing neuroendocrine tumors of the foregut, midgut and hindgut. Drug therapy is of special importance in patients with inoperable metastasising disease. This palliative therapy is aimed at reduction of the hormone-dependent symptoms and inhibition of tumor growth. Somatostatin analogues, α-interferon and various chemotherapeutic agents are used for this purpose. Drug therapy can be supplemented by surgical and radiological intervention through interdisciplinary cooperation of the surgeon, radiologist, endocrinologist and gastroenterologist.

Zusammenfassung

Karzinoide sind seltene neuroendokrine Tumore des Gastrointestinaltraktes, die charakteristischer Weise eine langsame biologische Wachstumstendenz aufweisen. Die medikamentöse Therapie ist von besonderer Bedeutung bei Karzinoid-Patienten mit inoperablem, metastasierten Tumorleiden. Die palliative Therapie bei diesen Patienten dient der Reduktion hormonabhängiger Symptome und der Hemmung des Tumorwachstums. Für die medikamentöse Therapie stehen hierbei Somatostatinanaloga, α-Interferon und verschiedene Chemotherapeutika zur Verfügung. Im Rahmen der interdisziplinären Zusammenarbeit des Chirurgen, des Radiologen, des Endokrinologen und des Gastroenterologen kann die medikamentöse Therapie mit chirurgischen und radiologisch-interventionellen Methoden ergänzt werden.

Literatur

  • 1 Arnold R, Trautmann M E, Creutzfeldt W. et al . Somatostatin analogue octreotide and inhibition of tumour growth in metastatic endocrine gastroenteropancreatic tumours.  Gut. 1996;  38 430-438
  • 2 Bukowski R M, Stephens R, Oishi N. Phase II trial of 5-FU, Adriamycin, cyclophosphamide, and streptozotocin in metastatic carcinoid.  Proc Am Soc Clin Oncol. 1983;  2 130
  • 3 Bukowski R M, Johnson K G. et al . A phase II trial of combination chemotherapy in patients with metastatic carcinoid tumors. A Southwest Oncology Group Study.  Cancer. 1987;  60 2891-2895
  • 4 Bukowski R M, Tangen C M, Peterson R F. et al . Phase II trial of dimethyltriazenoimidazole carboxamide in patients with metastatic carcinoid. A Southwest Oncology Group study.  Cancer. 1994;  73 1505-1508
  • 5 Bauer W, Briner U, Doepfner W. et al . SMS 201-995: a very potent and selective octapeptide analogue of somatostatin with prolonged action.  Life Sci. 1982;  31 1133-1140
  • 6 Capella C, Heitz P U, Hofler H, Solcia E, Kloppel G. Revised classification of neuroendocrine tumours of the lung, pancreas and gut.  Virchows Arch. 1995;  425 547-560
  • 7 Caplin M E, Buscombe J R, Hilson A J, Jones A L, Watkinson A F, Burroughs A K. Carcinoid tumour.  Lancet. 1998;  352 799-805
  • 8 Casper E S, Mittelman A, Kelson D, Young C W. Phase I clinical trial of fludarabine phosphate (F-ara-AMP).  Cancer Chemother Pharmacol. 1982;  15 233-235
  • 9 Clouse M E, Perry L, Stuart K, Stokes K R. Hepatic arterial chemoembolization for metastatic neuroendocrine tumors.  Digestion. 1994;  55 (Suppl 3) 92-97
  • 10 Connolly H M, Nishimura R A. et al . Outcome of cardiac surgery for carcinoid heart disease.  J Am Coll Cardiol. 1995;  25 410-416
  • 11 Engelbach M, Beyer J. Kapitel: Neuroendokrine Tumoren des Gastrointestinaltraktes. In: Nawroth, Ziegler (Hrsg). Klinische Endokrinologie und Stoffwechsel. Springer, Heidelberg 2001
  • 12 Frank M, Klose K J, Wied M. et al . Combination therapy with octreotide and alpha-interferon.  Am J Gastroenterol. 1999;  94 1381-1387
  • 13 Guillemin R. Peptides in the brain.  Science. 1978;  202 390-402
  • 14 Gyr K E, Meier R. Pharmacodynamic effects of Sandostatin in the gastrointestinal tract.  Digestion. 1993;  54 (Suppl 1) 14-19
  • 15 Hofland L J, van Koetsveld P M. et al . Relative potencies of the somatostatin analogs octreotide, BIM-23014, and RC-160 on the inhibition of hormone release by cultured human endocrine tumor cells and normal rat anterior pituitary cells.  Endocrinology. 1994;  134 301-306
  • 16 Janson E T, Ronnblom L, Ahlstrom H. et al . Treatment with alpha-interferon versus alpha-interferon in combination with streptozocin and doxorubicin in patients with malignant carcinoid tumors.  Ann Oncol Sep. 1992;  3 635-638
  • 17 Kelsen D P, Cheng E, Kemeny N. treptozotocin and Adriamycin in the treatment of apud tumors.  Proc Am Assoc Cancer Res. 1982;  23 433
  • 18 Krenning E P, Kwekkeboom D J, Oei H Y. et al . Somatostatin receptor scintigraphy in gastroenteropancreatic tumors.  Ann N Y Acad Sci. 1994;  733 416-424
  • 19 Kvols L K, Moertel C G, O'Connell M J. et al . Treatment of the malignant carcinoid syndrome. Evaluation of a long-acting somatostatin analogue.  N Engl J Med. 1986;  315 663-666
  • 20 Liebow C, Reilly C, Serrano M, Schally A V. Somatostatin analogues inhibit growth of pancreatic cancer by stimulating tyrosine phosphatase.  Proc Natl Acad Sci USA. 1989;  86 2003-2007
  • 21 Lundin L, Norheim I, Landelius J. et al . Carcinoid heart disease.  Circulation. 1988;  77 264-269
  • 22 Mascardo R N, Sherline P. Somatostatin inhibits rapid centrosomal separation and cell proliferation induced by epidermal growth factor.  Endocrinology. 1982;  111 1394-1396
  • 23 Mitty H A, Warner R R, Newman L H. et al . Control of carcinoid syndrome with hepatic artery embolization.  Radiology. 1985;  155 623-626
  • 24 Moertel C G, Hanley H A. Combination chemotherapy trials in metastatic carcinoid tumor and the malignant carcinoid syndrome.  Cancer Clin Trials. 1979;  2 327-334
  • 25 Moertel C G, Hanley J A, Johnson L AN. Streptozocin alone compared with streptozocin plus fluorouracil in the treatment of advanced islet-cell carcinoma.  Engl J Med. 1980;  303 1189-1194
  • 26 Moertel C G, Lefkopoulo M, Lipsitz S, Hahn R G, Klaassen D. Streptozotocin-doxorubicin, streptozotocin-fluorouracil, or chlorzotocin in the treatment of advanced islet cell carcinoma.  New Engl J Med. 1992;  326 519-523
  • 27 Neijt J P, Lacave A J, Splinter T A. et al . Mitoxantrone in metastatic apudomas.  Br J Cancer. 1995;  71 106-108
  • 28 Nilsson O, Kolby L, Wangberg B. et al . Comparative studies on the expression of somatostatin receptor subtypes, outcome of octreotide scintigraphy and response to octreotide treatment in patients with carcinoid tumours.  Br J Cancer. 1998;  77 632-637
  • 29 Norton J A. Surgical management of carcinoid tumors.  Digestion. 1994;  55 (Suppl 3) 98-103
  • 30 Oberholzer S. Karzinoide Tumoren des Dünndarms.  Frank Z Pathol. 1907;  1 426-429
  • 31 Öberg K. Treatment of neuroendocrine tumors.  Cancer Treat Rev. 1994;  20 331-355
  • 32 Otte A, Mueller-Brand J, Dellas S. et al . Yttrium-90-labelled somatostatin-analogue for cancer treatment [letter].  Lancet. 1998;  51 417-418
  • 33 Patel Y C, Srikant C B. Subtype selectivity of peptide analogs for all five cloned human somatostatin receptors (hsstr 1-5).  Endocrinology. 1994;  135 2814-2817
  • 34 Robiolio P A, Rigolin V H, Wilson J S. et al . Carcinoid heart disease.  Circulation. 1995;  92 790-795
  • 35 Rubin J, Ajani J, Schirmer W. et al . Octreotide acetate long-acting formulation versus open-label subcutaneous octreotide acetate in malignant carcinoid syndrome.  J Clin Oncol. 1999;  17 600-606
  • 36 Saltz L, Lauwers G, Wiseberg J, Kelsen D. A phase II trial of carboplatin in patients with advanced APUD tumors.  Cancer. 1993;  72 619-622
  • 37 Saltz L, Kemeny N, Schwartz G, Kelsen D. A phase II trial of alpha-interferon and 5-fluorouracil in patients with advanced carcinoid and islet cell tumors.  Cancer. 1994;  74 958-961
  • 38 Stewart P M, Kane K F, Stewart S E. et al . Depot long-acting somatostatin analog (Sandostatin-LAR) is an effective treatment for acromegaly.  J Clin Endocrinol Metab. 1995;  80 3267-3272
  • 39 Weiss R E, Reddi A H, Nimni M E. Somatostatin can locally inhibit proliferation and differentiation of cartilage and bone precursor cells.  Calcif Tissue Int. 1981;  33 425-430

Dr. M. Engelbach

Endokrinologische Gemeinschaftspraxis

Düsseldorferstraße 1-7

D-60329 Frankfurt/M.

Phone: 0 69/25 78 68-0

Fax: 0 69/23 52 16