Treatment Options

Treatments - Other

Hope for the patients with carcinoid syndrome; A new diagnostic tool to help the carcinoid cancer patients See article published by The Canadian Research Society

 

Biochemical assessment of niacin deficiency among carcinoid cancer patients. (Abstract)
Shah GM, Shah RG, Veillette H, Kirkland JB, Pasieka JL, Warner RR.
Am J Gastroenterol. 2005 Oct;100(10):2307-14.

(Full Text) with permission from the authors.

It has been shown that giving niacin supplementation to carcinoid patients not only resolves several common symptoms of carcinoid and pellagra, such as skin lesions and diarrhea/ steatorrhea, but also generally improves the health of the carcinoid patients (10, 12, 29). Therefore, our results warrant that niacin status should be determined for all carcinoid patients, so that active niacin replacement could be provided to biochemically niacin-deficient patients. In areas of the world where preformed niacin is not added to the food supply and screening of niacin status is not possible, all carcinoid patients should be supplemented with niacin as a preventative therapy.

Human Tumor Assay

Editor
Larry Weisenthal, MD, Phd
What is Cell culture drug resistance testing (CCDRT) ?
Also known as "chemotherapy sensitivity and resistance assays" or ("CSRAs")

This journal describes the use of CCDR and its use to identify the best forms of chemotherapy for cancer patients on an individual basis.

Treatments - Biotherapy - Somatostatin

A Personal Overview of Sandostatin

From Al Simms' personal website. This page contains the Preparation and Administration booklet for Sandostatin.

About octreotide (Sandostatin)

This link is a to the Novartis Oncology website. This site has disease and product information for the US and International health-care professional as well as general information about Carcinoid/Vipoma for patients and caregivers.
How Do I Obtain Health Care Insurance Reimbursement Information?
Dosaging Flow Chart


Information site for carcinoid patients by Novartis. The carcinoid syndrome website for patients and their caregivers is completed and now up! This site, intended for the newly diagnosed and those living with carcinoid syndrome, features "questions to ask your doctor" and a sign-up program to receive updated information from Novartis.Take a look at the Resources section (http://www.carcinoid.com/info/resources/downloads.jsp) to see the detailed scientific information in the form of flash animations.

For comprehensive information regarding the use of the somatostatin analogue Sandostatin in the forms of subcutaneous injection (SC), long-acting injection(Sandostatin LAR) and continuous subcutaneous infusion via a pump

(pump-based therapy) read the following newly published paper by Dr. Eugene Woltering (2005)
A discussion on the utility of various routes of administration of octreotide acetate (Full text access with permission from the author)

Generic Octreotide:

Teva Pharmaceuticals
  Supplies short-acting octreotide.

Bedford Laboratories
Supplies short-acting octreotide.

Treatments - Biotherapy - Alpha

Treatments - Surgery - Anesthesia

Anesthesia During Labor (Full Text)

Download PDF

Anesthesia for patients with carcinoid syndrome (Abstract)

This link is to an abstract on PubMed.
Vaughan DJ, Brunner Mct on PubMed.
D.
Int Anesthesiol Clin. 1997 Fall;35(4):129-42.
".....Carcinoid syndrome, although rare, can create serious problems to the anesthetist, both by the nature and variability of clinical manifestations and by the complications that can occur peroperatively............................The severity of symptoms does not predict the severity of perioperative complications, so that patients with minor preoperative symptoms may have significant intraoperative complications. .........................The keys to successful anesthetic management of patients with carcinoid syndrome are good communication between endocrinologist, anesthetist, and surgeon and preoperative optimization of the patient...............Octreotide has largely replaced the use of other drugs both for symptomatic control and acute treatment of the symptoms associated with carcinoid syndrome......"

Octreotide treatment of carcinoid hypertensive crisis (Abstract)

For full text article contact the Carcinoid Cancer Foundation™ 888-722-3132
Warner RR, Mani S, Profeta J, Grunstein E.
Mt Sinai J Med. 1994 Sep;61(4):349-55."
".......We suggest that hypertensive as well as hypotensive carcinoid crises respond to octreotide and that this agent should be considered for prophylactic and emergency use in all carcinoid syndrome patients prior to and during anesthesia and surgery."

Perianaesthetic risks and outcomes of abdominal surgery for metastatic carcinoid tumours

(Full text PDF)
By Kinney MA, Warner ME, Nagorney DM, Rubin J, Schroeder DR, Maxson PM, Warner MA.
Br J Anaesth. 2001 Sep;87(3):447-52.

Treatments - Surgery - liver

Chemoembolization and Bland Embolization of Neuroendocrine Tumor Metastases to the Liver (Full text)

Full Text PDF

J Vasc Interv Radiol. 2007 Jul;18(7):847-55
Ruutiainen AT, Soulen MC, Tuite CM, Clark TW, Mondschein JI, Stavropoulos SW, Trerotola SO.
Division of Interventional Radiology, University of Pennsylvania, 1 Silverstein, Philadelphia, PA 19104, USA.

(Abstract)
CONCLUSIONS: Chemoembolization was not associated with a higher degree of toxicity than bland embolization. Chemoembolization demonstrated trends toward improvement in TTP, symptom control, and survival. Based on these results, a multicenter prospective randomized trial is warranted

Chemoembolization for Hepatic Malignancies,

Full Text PDF


by Michael C. Soulen, MD, Associate Professor of Radiology & Surgery, University of Pennsylvania, Philadelphia, PA

Chemoembolization Information

Provided by Radiology Info and Radiological Society of North America, Inc. (RSNA)

Information about Chemoembolization, Radiofrequency Ablation, Radioisotope (Y90) (SirSperes, TheraSpheres,) and other surgical treatments targeted for liver tumors

  • Yttrium-90 microsphere radioembolization is a new non-surgical procedure used to treat inoperable liver cancer by delivering targeted, internal radiation

    For Medical Centers in the US that peform
    Theraspheres  CLICK HERE
    SirSpheres   CLICK HERE

    NOTE 1: YES "When the impossible is possible"
    This site gives information and support to patients who have undergone treatment with Yttrium 90 Microsphere.
    Their toll free survival number is
    1-877-937-7478

    NOTE 2: Read about one patient's experience with Y 90 treatement for liver metastases in the January and March issue of the MNYCSG newsletter below.

    JANUARY AND MARCH 2007 The Metro NY Carcinoid Support Group's (MNYCSG) January and March 2007 newsletters (in PDF format) are now available.
    A MUST READ !!!
    Click here for the January newsletter.
    Click here for the March newsletter
    Besides carcinoid comunity news these two issues contain a special section on "The Yttrium 90 Treatment --- One Patient's Experience"
    To contact the author of this fabulous newsletter click on the following link (Jim Weiveris)
    For past  and later newsletter and other relevant information visit the MNYSG website at http://www.carcinoid.

NEW Original Article

Prolonged survival after hepatic artery embolization in patients with midgut carcinoid syndrome.(Full Text)
by Swärd C, Johanson V, Nieveen van Dijkum E, Jansson S, Nilsson O, Wängberg B, Ahlman H, Kölby L on April 10, 2009 in British Journal of Surgery
Conclusion:
Hepatic Arery Embolization is safe, provides good control of hormonal symptoms, and prolongs survival in biochemically responsive patients. It is a valuable palliative option for patients with midgut carcinoid syndrome due to liver metastases and can be repeated in patients with a favourable response to the first procedure. Copyright (c) 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.PMID: 19358175 [PubMed - as supplied by publisher].........read full text

Radio Frequency Ablation (RFA) Cleveland Clinic,

The following pages contain information for patients about the Liver Tumor Radio Frequency Ablation Program. The information will answer questions patients may ask when considering a new treatment method.

Radiofrequency ablation (RFA) Information

Provided by Liver Tumor Ablation Program at the University of California, San Francisco

Radiofrequency Ablation of Liver Tumors

Provided by Radiology Info and Radiological Society of North America, Inc. (RSNA)

SIR-Spheres ( Yttrium 90 targeted for liver tumors)

Patient Booklet PDF

What are SIR-Spheres?
SIR-Spheres are tiny polymer (plastic) beads (about one third the diameter of a strand of hair) that are combined with yttrium-90, a radioisotope that emits pure beta radiation. Y90 (yttrium-90) has a “half life” of about 64 hours, that is, every 64 hours the level of radiation falls by one half until it is effectively gone after 2 weeks. The radiation from Y90 penetrates an average of only 2.5 mm (approximately 1/16 of an inch) in tissue. After injection into the artery supplying blood to the tumors, the spheres are trapped in the tumor’s vascular bed, where they destroy the tumor cells by delivering the beta radiation. The radiation is targeted to the tumor and after 14 days the majority of the radiation effect has occurred. SIR-Spheres are considered a regional treatment as the radiation is directed to the liver and does not affect other organs in the body.

US Treatment Centers

Treatments - Radioisotope

Erasmus MC Lutetium 177 Treatment *

Moleculare RadioTherapy (Website with contact information)
Information about the Receptor therapy given to patients in the Netherlands ......Read More
How to Reach us Click Here
Postal address
P.O. box 2040
3000 CA Rotterdam, NL
Street address
Dr. Molewaterplein 40
3015 GD Rotterdam, NL
Direct dial +31-10-4635963
Fax number +31-10-4635997
Comment: Head of Department
Prof. Dr. Eric.P. Krenning

FDA Approves Novel Radio-peptide Targeted Therapy Clinical Trial for Neuroendocrine Cancer: PRRT (Peptide Receptor Radionuclide Therapy)

For the first time in North America, neuroendocrine cancer patients have the opportunity to participate in a clinical trial of Lutetieum-177 (LU-177) with Octreotate.   Ebrahim S. Delpassand, MD, chief executive officer and medical director of Excel Diagnostics (pictured below),  announced that after several years of careful review the Food and Drug Administration (FDA) has approved the investigational new drug clinical trial.  Excel Diagnostics and Nuclear Oncology Center in Houston, Texas is the first research facility in the United States to receive authorization to initiate this much needed therapy.Ebrahim Delpassand, MD


Lutetieum-177 radionuclide is one of the radioactive materials used in PRRT, peptide receptor radionuclide therapy, as is Y-90 (Yttrium-90). When labeled with somatostatin analogs such as Octreotate, these agents can be used for progressive neuroendocrine tumors that are resistant to octreotide/interferon treatment or chemotherapy.  LU-177 Octreotate has been used in Europe for over a decade and is also available in Australia and India. It has a shorter path length in the tissue than Y-90 has and is less toxic to both the kidneys and bone marrow. During the past 15 years, studies of radio-peptide therapy for various neuroendocrine cancers have shown good clinical and radiological results with minimal side effects.

LU-177 Octreotate is administered along with intravenous amino acids, to protect the kidneys from radiation.  The Octreotate binds to somatostatin receptors on cells, thus providing highly targeted radiation to the tumors.  A patient has 4 sessions of the treatment, spaced six to ten weeks apart. The use of LU-177 Octreotate as a targeted treatment was pioneered by Dr. Eric Krenning and Dr. Dik J. Kwekkeboom at Erasmus Medical Center in Rotterdam, the Netherlands.

This therapy can be used for neuroendocrine tumors including carcinoid, islet cell carcinoma of the pancreas, oat cell carcinoma of the lung, pheochromocytoma, gastro-entero-pancreatic neuroendocrine tumors (GEPNETS), and rare thyroid cancers unresponsive to radioiodine.

The principal investigator for the U.S. program is Dr. Ebrahim S. Delpassand and the project is in collaboration with Baylor College of Medicine, St. Luke’s Episcopal Hospital and Radio-Isotope Therapy of America (RITA) Foundation in Houston.

For further information regarding this treatment, contact Ms. Susan Cork, therapy patient coordinator, at 713-341-3203 or scork@exceldiagnostics.com.

Many European Countries now have systemic radioistotope therapies available;

Netherlands, UK, Switzerland, Germany, Canada and Sweden.
Please contact ENETS ( the European Neuroendocrine Tumor Society) for location and contact iinformation.  http://www.neuroendocrine.net/

Radioisotope Treatment with LU -177

See information about this treatment and contact information
It is a very thorough guide to the treatment process and clearly spells out the steps that need to be taken to get to Erasmus MC.
http://www.prrt.nl/index.php?lang=en

Read this fascinating description by a patient who has undergone the LU-177 isotope treatment in Australia..

Eric's carcinoid journey and experience with LU-177 treatment

Systemic Radioisotope treatment now available in the US.

“High Dose Indium-111 Pentetreotide (Octreotide) Therapy in Somatostatin  Receptor Expressing  Neuroendocrine Neoplasms.” 
High-dose 111In-Pentetreotide (~500 mCi/patient) is now offered in the U.S. for therapy in somatostatin receptor expressing neuroendocrine tumors. This is based on the Investigational New Drug (IND) application filed with FDA. Using this innovative method of cancer therapy, a somatostatin receptor analog (called Pentetreotide) is labeled with a high dose of a radioactive element called Indium-111. Pentetreotide will carry Indium-111 to the site of the tumor and attaches to the receptor site located on the cell membrane. The next step is internalization of  the compound into the cell cytoplasm and next to the cell nucleus. Radioactivity is then deposited in this region and causes damage to the DNA molecules located in the nucleus of the cancer cells. The net effect will be initial dysfunction of the tumor cells, followed by prevention of further tumor growth and leading to cell death.

This therapy can be applied to the category of neuroendocrine tumors which include Carcinoid, Islet Cell Carcinoma of the Pancreas, Oat Cell Carcinoma of the Lung, and Medullary Thyroid Carcinoma” .

The principle investigator of this program is Dr. Ebrahim S. Delpassand and the project is in collaboration with Excel diagnostic Imaging Clinics, St. Luke’s Episcopal Hospital and RadioIsotope Therapy of America (RITA) Foundation in Houston.

For further information regarding this treatment, you can contact Ms. Christiane Assir clinical coordinator of the project at: 713-341-3239.
cassir@exceldiagnostics.com