Long-term disease control of a pancreatic neuroendocrine tumor with lanreotide autogel(®): a case report

Abstract

The CLARINET study (ClinicalTrials.gov: NCT00353496) showed that somatostatin analogs are able to stabilize tumor growth in patients with intestinal and pancreatic neuroendocrine tumors (NETs). Here, we present a case of NET originating from the pancreatic tail that was treated with lanreotide Autogel(®). A 60-year-old patient underwent resection of a pancreatic NET with splenectomy and distal pancreatectomy. Four months after surgery, there was an increase in chromogranin A levels, along with a hypercaptating lesion of approximately 3.5 cm at the residual part of the pancreatic corpus. Treatment with 30 mg monthly-administered octreotide long-acting release (LAR) was initiated. After 3 months of treatment, a control CT scan revealed diffuse metastases in the liver, although the patient presented no symptoms and liver tests were normal. Due to difficulties with the administration of octreotide LAR, treatment was switched to lanreotide Autogel(®) 120 mg, administered as monthly deep-subcutaneous injections. Progression-free survival, as shown by 3-monthly CT scans, was obtained for 2 years without the need to increase the lanreotide Autogel(®) dose, and the patient reported no side effects. After these 2 years, deterioration of the patient's clinical status and weight loss were observed, along with increased size of the liver lesions and appearance of peritoneal metastases. Chemotherapy treatment with cisplatinum-etoposide was initiated, while the lanreotide Autogel(®) injections were continued. After three chemotherapy cycles, a rapid decline in the patient's quality of life was noted, and she requested discontinuation of the chemotherapy and lanreotide injections. One month later, the patient died due to clinical progressive disease.

Keywords: Lanreotide Autogel®; Pancreatic neuroendocrine tumor; Somatostatin analog.

Figures

Fig. 1

CT scan at diagnosis (April 2011). The CT scan of the abdomen revealed a large tumor in the left hypochondriac region, located cranial to the tail of the pancreas and expanding into the spleen; there was no invasion of the kidneys or adrenal glands.

Fig. 2

Microscopic examination of the tumor biopsy. a, b Hematoxylin and eosin staining showed a lesion with a solid and nested growth pattern containing cells with clear cytoplasm, well-defined cell borders and small, slightly pleomorphic nuclei. Focal positivity for CD10 (c) and strong vimentin immunoreactivity (d) was observed.

Fig. 3

CT scans at follow-up visits. a–c The CT scan in January 2012 revealed multiple small lesions with early arterial enhancement in the parenchyma of the liver, indicative of hypervascular metastases. No ascites was observed. d, e The CT scan in November 2013 revealed an increase in size of the liver lesions and presence of peritoneal metastases with a low level of ascites.