Clinical impact of unsuccessful subcutaneous administration of octreotide LAR instead of intramuscular administration in patients with metastatic gastroenteropancreatic neuroendocrine tumors

IF 3.3 4区 医学 Q2 ENDOCRINOLOGY & METABOLISM
Tharani Krishnan, Maria Safro, Daniel Moreira Furlanetto, Sharlene Gill, Joao Paulo Solar Vasconcelos, Heather C. Stuart, Patrick Martineau, Jonathan M. Loree
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引用次数: 0

Abstract

Octreotide LAR is a long-acting somatostatin analogue (SSA) used in the management of metastatic gastroenteropancreatic neuroendocrine tumors (GEP NETs). It requires intramuscular (IM) injection. Missed IM injections cause subcutaneous nodules (SCNs) on radiologic images. We reviewed the rates of SCNs in a real-world cohort of GEP NETs receiving octreotide LAR and explored treatment outcomes. Patients commencing octreotide LAR between August 5, 2010 and March 8, 2018 at a single cancer center in Canada were identified from pharmacy records. Patients were included if they had a computed tomography (CT) scan performed at the time of progression and a preceding CT with pelvis included to enable assessment for the presence of nodules. Fisher's exact test was used to examine predictors of SCNs, and Kaplan–Meier curves summarized differences in progression free (PFS) and overall survival (OS) that were compared with log-rank tests. Of 243 patients receiving octreotide LAR, 45 had all required CT images available for central review. SCNs were found in 20/45 (44%) of patients on the last scan showing stable disease before progression and were numerically but not statistically more likely in females (OR: 2.36, 95% CI: 0.66–8.29, p = .23). There was an increased risk of SCNs in patients with a skin-to-muscle distance >38 mm (the length of an octreotide LAR needle) on CT (OR: 5.09, 95% CI: 1.39–16.6, p = .018) and a trend toward increased risk in obese patients (OR: 5.71, 95% CI: 1.26–23.4, p = .061). PFS (HR: 1.01, 95% CI: 0.56–1.78, p = .98) and OS (HR: 0.86, 95% CI: 0.41–1.8, p = .70) was similar between those with/without SCNs. In conclusion, almost half of patients receiving octreotide LAR had SCNs; however, missed administration of SSA did not appear to result in worse survival in this small study. Factors such as sex, younger age skin-to-muscle distance, and obesity may affect SCN development and should be considered when choosing an SSA.

Abstract Image

Abstract Image

转移性胃肠胰神经内分泌肿瘤患者皮下注射奥曲肽 LAR 而非肌肉注射奥曲肽不成功的临床影响
奥曲肽 LAR 是一种长效体生长抑素类似物(SSA),用于治疗转移性胃肠胰神经内分泌肿瘤(GEP NETs)。它需要肌肉注射(IM)。错过 IM 注射会导致放射影像上出现皮下结节 (SCN)。我们回顾了接受奥曲肽 LAR 治疗的 GEP NET 患者的皮下结节发生率,并探讨了治疗效果。我们从药房记录中确定了2010年8月5日至2018年3月8日期间在加拿大一家癌症中心开始使用奥曲肽LAR的患者。如果患者在病情进展时进行了计算机断层扫描(CT),且之前进行了骨盆CT扫描以评估是否存在结节,则纳入该患者。费舍尔精确检验用于检测SCN的预测因素,Kaplan-Meier曲线总结了无进展生存期(PFS)和总生存期(OS)的差异,并通过对数秩检验进行了比较。在接受奥曲肽 LAR 治疗的 243 例患者中,有 45 例患者的所有 CT 图像均可进行集中审查。20/45(44%)的患者在病情进展前的最后一次扫描中发现了SCN,女性患者中SCN的发生率更高(OR:2.36,95% CI:0.66-8.29,P = .23)。CT上皮肤到肌肉的距离为38毫米(奥曲肽LAR针的长度)的患者发生SCN的风险增加(OR:5.09,95% CI:1.39-16.6,p = .018),肥胖患者发生SCN的风险有增加的趋势(OR:5.71,95% CI:1.26-23.4,p = .061)。有/无 SCN 的患者的 PFS(HR:1.01,95% CI:0.56-1.78,p = .98)和 OS(HR:0.86,95% CI:0.41-1.8,p = .70)相似。总之,在接受奥曲肽 LAR 治疗的患者中,近一半存在 SCN;但在这项小型研究中,漏服 SSA 似乎并不会导致生存率降低。性别、年轻时皮肤到肌肉的距离以及肥胖等因素可能会影响 SCN 的形成,因此在选择 SSA 时应加以考虑。
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来源期刊
Journal of Neuroendocrinology
Journal of Neuroendocrinology 医学-内分泌学与代谢
CiteScore
6.40
自引率
6.20%
发文量
137
审稿时长
4-8 weeks
期刊介绍: Journal of Neuroendocrinology provides the principal international focus for the newest ideas in classical neuroendocrinology and its expanding interface with the regulation of behavioural, cognitive, developmental, degenerative and metabolic processes. Through the rapid publication of original manuscripts and provocative review articles, it provides essential reading for basic scientists and clinicians researching in this rapidly expanding field. In determining content, the primary considerations are excellence, relevance and novelty. While Journal of Neuroendocrinology reflects the broad scientific and clinical interests of the BSN membership, the editorial team, led by Professor Julian Mercer, ensures that the journal’s ethos, authorship, content and purpose are those expected of a leading international publication.
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