PMID- 32405630
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200928
VI  - 3
IP  - 2
DP  - 2020
TI  - Chronic Use of Long-Acting Somatostatin Analogues (SSAs) and Exocrine Pancreatic 
      Insufficiency (EPI) in Patients with Gastroenteropancreatic Neuroendocrine Tumors 
      (GEP-NETs): An Under-recognized Adverse Effect.
PG  - 75-84
AB  - BACKGROUND: Somatostatin Analogues (SSAs) are used to treat 
      Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) and acromegaly. Side 
      effects of SAAs usually include biliary disorders, gastrointestinal disorders, 
      injection-site pain and hyperglycemia. Exocrine Pancreatic Insufficiency (EPI) is 
      often misdiagnosed as disease progression or failure to SAAs or diagnosed after a 
      delay in patients receiving SAAs. We present our experience with EPI developing 
      in patients following use of SAAs. METHODS: We reviewed chart and pharmacy 
      records of 110 GEP-NETs patients who received SSAs. Data was collected including 
      demographics, pathology, stage, dose/duration of long and short-acting SA, use of 
      antidiarrheal, pancreatic enzyme replacement (PER), proton pump inhibitors (PPI) 
      or H2 blockers). Laboratory data include chromogranin-A (CgA), urine 5-HIAA and 
      quantitative fecal fat test (QFFT) or fecal elastase test (FE). EPI was defined 
      by a FE below normal level OR by a reduction of >/= 21.2% or steatorrhea on QFFT. 
      Patients who were identified to develop EPI were treated with pancreatic exocrine 
      replacement therapy (PERT). RESULTS: Among, 110 GEP-NETs patients, 104 received 
      LA Octreotide and 6 Somatuline Depot Injection. Of these, 23 received 
      short-acting SSA for worsening diarrhea, 96 had intensification of antidiarrheal 
      and 1 got telotristat ethyl. QFFT confirmed EPI in 19, 11 based on clinical 
      symptoms, and 16 had sample error or refusal to collect specimen. CTCAE 4.0 
      grades of EPI were: grade 2(69%), grade 3(22%) and grade 4(9%). Median time to 
      development of EPI was 12 months (95%CI 3 - 23). Except 1, all patients received 
      PERT either with concomitant PPI (13) or later if no improvement with PERT (6) 
      and 2 on H2 blockers. 37% of the patients had improvement in EPI within 4-8 
      weeks. Deficiency of vitamins and trace elements was found in 11 of 19 patients, 
      who received supplementation. CONCLUSIONS: Our experience constitutes the first 
      and the largest study addressing EPI as a rare but serious complication of 
      chronic use of SAAs. Although SAAs are used to treat diarrhea, paradoxically they 
      can worsen diarrhea secondary to EPI. Early recognition and diagnosis of this 
      under-diagnosed and under-reported side effect of SAAs, such as EPI, can improve 
      not only diarrhea and weight loss in these patients but also can reduce cost of 
      using short-acting SAAs and antidiarrheal.
FAU - Saif, Muhammad Wasif
AU  - Saif MW
AD  - Department of Medical Oncology, Northwell Health Cancer Institute, Donald and 
      Barbara Zucker School of Medicine at Hofstra and Feinstein Institute for Medical 
      Research, USA.
AD  - Tufts Medical Center, Boston, MA, USA.
FAU - Romano, Alicia
AU  - Romano A
AD  - Tufts Medical Center, Boston, MA, USA.
FAU - Smith, Melissa H
AU  - Smith MH
AD  - Tufts Medical Center, Boston, MA, USA.
FAU - Patel, Rachana
AU  - Patel R
AD  - Tufts Medical Center, Boston, MA, USA.
FAU - Relias, Valerie
AU  - Relias V
AD  - Tufts Medical Center, Boston, MA, USA.
LA  - eng
GR  - UL1 TR001064/TR/NCATS NIH HHS/United States
PT  - Journal Article
DEP - 20200427
PL  - India
TA  - Cancer Med J
JT  - Cancer medicine journal
JID - 101744997
PMC - PMC7219785
MID - NIHMS1587107
OTO - NOTNLM
OT  - Chronic pancreatitis
OT  - Clinical studies
OT  - Exocrine pancreatic insufficiency
OT  - Gastric surgery
OT  - Gastroenteropancreatic neuroendocrine tumors (GEP-NET)
OT  - Lanreotide
OT  - Pancreatic neoplasms
OT  - Pancreatic surgery
OT  - Risk factors
OT  - Somatostatin
EDAT- 2020/05/15 06:00
MHDA- 2020/05/15 06:01
PMCR- 2020/05/13
CRDT- 2020/05/15 06:00
PHST- 2020/05/15 06:00 [entrez]
PHST- 2020/05/15 06:00 [pubmed]
PHST- 2020/05/15 06:01 [medline]
PHST- 2020/05/13 00:00 [pmc-release]
PST - ppublish
SO  - Cancer Med J. 2020;3(2):75-84. Epub 2020 Apr 27.