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Published in: Endocrine 1/2018

01-04-2018 | Review

The Zollinger-Ellison syndrome: is there a role for somatostatin analogues in the treatment of the gastrinoma?

Authors: Valentina Guarnotta, Chiara Martini, Maria Vittoria Davì, Genoveffa Pizza, Annamaria Colao, Antongiulio Faggiano, on behalf of NIKE group

Published in: Endocrine | Issue 1/2018

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Abstract

Purpose

Analyze the role of somatostatin analogues (SSAs) in the treatment of sporadic and MEN1-related gastrinomas, trying to define whether recent trials have changed the landscape of gastrinoma therapy.

Methods

We evaluate the rationale of SSA use in the treatment of gastrinomas, summarize the current literature concerning the effect of SSAs on the control of Zollinger-Ellison syndrome (ZES) and gastrinomas tumor progression and discuss their role in the most recent guidelines.

Results

The medical treatment of gastrinoma and related ZES is aimed at controlling acid hypersecretion and tumor progression, in inoperable patients. The use of proton pump inhibitors (PPIs) to control the syndrome is a cornerstone in the ZES therapy. SSAs are not usually indicated for antisecretory purpose, because PPIs are considered the treatment of choice, due to their long lasting high efficacy and oral availability. The antiproliferative effect of SSAs has been established by two placebo-controlled trials that have clearly demonstrated a significant increase in progression free survival in patients affected by non-functioning well-differentiated advanced neuroendocrine tumors (NETs). The recent ENETS guidelines recommend the use of SSAs in advanced well differentiated NETs as antiproliferative agents.

Conclusions

The high sstr-expression in gastrinomas make them highly responsive to SSAs and support the use of such drugs to counteract the tumour growth in patients not amenable to surgical cure. Unfortunately, limited data, mainly case reports or small series, support the use of SSAs in advanced gastrinomas, therefore, it is difficult to quantify their ability to control tumour growth and disease progression.
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Metadata
Title
The Zollinger-Ellison syndrome: is there a role for somatostatin analogues in the treatment of the gastrinoma?
Authors
Valentina Guarnotta
Chiara Martini
Maria Vittoria Davì
Genoveffa Pizza
Annamaria Colao
Antongiulio Faggiano
on behalf of NIKE group
Publication date
01-04-2018
Publisher
Springer US
Published in
Endocrine / Issue 1/2018
Print ISSN: 1355-008X
Electronic ISSN: 1559-0100
DOI
https://doi.org/10.1007/s12020-017-1420-4

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