Somatostatin analogues: The state of the art.

The somatostatin analogues (SST analogues) octreotide and lanreotide improve the quality of life by providing symptomatic relief in up to 100% of cases. Unfortunately the objective response rate is low (7-28%) and the stabilization rate is about 80%. The impact on survival has not been established. Predictors of poor response are: pancreatic tumor, no previous surgery, distant extrahepatic metastases, high proliferative index (Ki675%), and weight loss. The European Neuroendocrine Tumor Society (ENET) guidelines recommend the SST analogues as first line therapy for Octreoscan-positive tumors, endocrine tumors associated with a syndrome, progressing tumors, and for the prevention of carcinoid crises during surgery. Their use after surgery, debulking, chemoembolization, and other procedures as adjuvant therapy in patients with residual disease after surgery and in the presence of asymptomatic metastases is controversial. At present, the best method is to adopt a multidisciplinary approach. Novel compounds may improve outcome in the near future.