Somatostatin analogues (SSA) have an established role in the medical management of patients with neuroendocrine tumours (NETs). They are effective in the symptomatic treatment of some metastatic NETs and may also provide tumour stabilisation or reduction. We report two patients with disease progression who benefited from SSA. Mrs HW, 64-year old woman, was diagnosed with a grade 1 small-bowel NET with lymph node and liver metastasis in 2012: Ki-67 index < 1%. Despite a segmental bowel, metastatic lymph node and liver segment resection in 2012, she had disease progression with para-aortic, mesenteric lymph node and bilateral breast deposits in 2016. Histology from the breast deposits confirmed neuroendocrine features with Ki-67 <5%. In July 2016, she started SSA with Lanreotide. Serial imaging from August 2016, February 2017 and June 2017 has since confirmed no disease further progression, highlighting the success of SSA therapy. Mrs BW, 58-year old woman, was diagnosed with a grade 2 right kidney NET secreting somatostatin with liver metastasis in 2010. She underwent a right hepatic arterial embolization (September 2010), right nephrectomy (December 2011) with Ki-67 index <10%, and completed systemic chemotherapy in September 2013. In February 2016, there was a marked increase in somatostatin levels and disease progressions on imaging, prompting SSA to be commenced. Since starting SSA with Octreotide LAR, her subsequent imaging from February 2016, September 2016 and February 2017 has demonstrated stable disease. She is unkeen for further systemic therapy other than SSA. Our cases demonstrate two patients with advanced and metastatic NETs. In both cases, they had disease progression prior to starting SSA and have both benefited from clinical and radiological disease stability since starting therapy.
04 Dec 2017
UK and Ireland Neuroendocrine Tumour Society