Treatment options

It is possible that with treatment of neuroendocrine tumors, the symptoms of carcinoid syndrome can be better managed and even improved.

If the tumor can be removed, completely or partially—a surgical process called debulking the tumor— the symptoms of carcinoid syndrome may decrease.

At present, the only opportunity for a cure for NETs is the removal of all tumor tissue surgically. However other forms of treatment can greatly prolong duration and quality of life.

Managing the symptoms of carcinoid syndrome

Anti-diarrheal treatments

Anti-diarrheal medications, like loperamide and diphenoxylate-atropine, can be helpful in controlling diarrhea caused by carcinoid syndrome.

You should talk to a NETs specialist before trying or adding one of these options to your treatment plan.

Diet and Medication Adjustments

Your healthcare team may recommend that you avoid foods and substances that have high levels of mines, nitrogen-containing organic compounds, or adrenaline-like substances or alcohol as they can trigger the release of serotonin and other hormones from your tumor. These foods include fatty meats, smoked or salted fish, aged cheeses, chocolate and red wine.

You should also avoid foods with high serotonin levels such as eggs, cheese, pineapple, nuts, bananas, tomatoes, kiwi fruit and plums.

Prescription medications may also affect your amine or adrenaline levels—be sure to ask your doctor about this.

Palliative Therapy

Palliative therapy, also known as supportive care, is often used to help manage pain, maintain quality of life, and reduce the stress that comes with a serious illness.

Palliative therapy can relieve symptoms and help individuals live more comfortably. It focuses on treating the symptoms, side effects, and emotional aspects that people in cancer treatment, and their families, often experience.

Examples of palliative therapy include surgery to lessen the tumor size and reduce pain and counseling with a therapist to mitigate mental stress and emotional burdens.

PRRT (Peptide Receptor Radionuclide Therapy)

With PRRT, octreotide is combined with a radioactive isotope (for example Lutetium 177)—creating a special type of radiopharmaceutical called a radiopeptide.

When injected into the body, this radiopeptide travels to and binds to neuroendocrine tumor cells, delivering a high dose of radiation to the tumor.

Somatostatin Analogs (SSA)

Injections of somatostatin analogs can be used to lesson symptoms of carcinoid syndrome, including diarrhea and flushing.

These medications include octreotide (brand name: Sandostatin Depot) and lanreotide (brand name: Somatuline Depot). They help block the production of hormones such as serotonin, reducing the flushing and diarrhea associated with carcinoid syndrome. Octreotide can be prescribed in long-acting (brand name: Sandostatin LAR) and short-acting (brand name: Sandostatin Depot) forms depending on the need determined by your care team.

Many individuals with carcinoid syndrome are prescribed regular injections of octreotide or lanreotide to help control symptoms.

Telotristat ethyl

Telotristat ethyl (brand name: Xermelo) was recently approved in the U.S. for the treatment of diarrhea caused by carcinoid syndrome, in conjunction with other therapies. It targets the overproduction of serotonin within neuroendocrine tumorcells and is taken in combination with a somatostatin analog when the SSA alone is not fully effective.

Your doctor will recommend the best combination of therapies needed for your individual treatment plan. These may change as your treatment continues.

Find out more about clinical trials

Clinical drug trials are in progress for NETs, as are trials of other therapies that may be helpful in the treatment of cancer.

Clinical Trials

Treating neuroendocrine tumors

Biologics

A biologic therapy is derived from living tissues or cells that have been genetically modified. Biologics, sometimes in combination with chemotherapy, are used to treat NETs, and can reduce the symptoms of carcinoid syndrome.

Interferon is a biologic therapy that sometimes is used in the treatment of NETs. It can also be effective in the treatment of persistent symptoms, like flushing and diarrhea, which are common with carcinoid syndrome.

Chemotherapy

A common form of cancer treatment, chemotherapy uses drugs to stop the growth of cancer cells or minimize cancer spread.

CAPTEM, a combination of two anti-cancer medications, capecitabine and temozolomide, is used in tumors that have not responded to high-dose octreotide.

5-fluorouracil (5-FU) is the chemotherapy most studied in the treatment of neuroendocrine tumors, and has shown to be effective in reducing tumor growth in some cases.

5-fluorouracil (5-FU) in combination with streptozotocin has shown to be effective in the reduction of tumor size and growth as well.

Doxorubicin, streptozotocin, dactinomycin, and dacarbazine have also been studied for the treatment of neuroendocrine tumors.

Immunotherapy

An immunotherapy can boost the immune system and help improve the body’s natural defenses against foreign growths such as tumors. Some immunotherapies target a protein called PD-1. This protein stops the immune system from attacking cancer cells. Stopping PD-1 helps the immune system focus on destroying the cancer cells themselves.

Radiation Therapy

Radiation therapy uses X-rays to attack cancer cells and shrink tumor size. Radiation therapy can be externally applied and directed by a machine outside the body. It can also be internally applied with the use of implants inside the body.

A schedule for radiation treatment is typically created that calls for a specific number of treatments spaced out over a period of time.

Somatostatin Analogs (SSA)

Somatostatin analogs such as octreotide (brand name: Sandostatin LAR and Sandostatin) and lanreotide (brand name: Somatuline Depot) are mainstay therapies for the management of carcinoid syndrome symptoms such as diarrhea and flushing.

SSA’s may also help to reduce the growth of neuroendocrine tumor cells.

Octreotide can be prescribed as a daily injection, or as a ‘rescue’ injection that you can administer at home, when symptoms become difficult to manage.

Surgery

Depending on the size and location of the tumor, surgery may be an option to remove the tumor. Surgery can also be used to reduce the size of the NET, which can help alleviate the symptoms of carcinoid syndrome. This is called debulking.

Targeted Therapy

Targeted therapies attack tumors cells while minimizing damage to normal cells. These include:

Angiogenesis Inhibitors (AI)

Having an adequate blood supply is important in the growth of a tumor. Angiogenesis is the formation of new blood vessels in the body.

Angiogenesis is controlled by chemical signals. An angiogenesis inhibitor interferes with those signals and slows the formation of new blood vessels that supply the tumors.

Angiogenesis inhibitors that have been studied for the treatment of neuroendocrine tumor include sunitinib (brand name: Sutent) and bevacizumab (brand name: Avastin).

Tyrosine Kinase Inhibitors (TKI)

TKIs are drugs that impact a natural chemical in the body called tyrosine kinase. These agents have been studied in the treatment of neuroendocrine tumors in the pancreas.

Sorafenib (brand name: Nexavar) and sunitinib (brand name: Sutent) are tyrosine kinase inhibitors.

mTOR Inhibitors

This is a class of therapies that inhibits the mammalian target of rapamycin. These therapies work to limit NET cell metabolism and growth by communicating with two proteins within the body known as mTORC1 and mTORC2. These therapies include everolimus (Afinitor) which is a different type of kinase inhibitor than sorafenib.

For more treatment options for NETs, click here.

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Eating healthy can help with symptom management

Managing the symptoms of carcinoid syndrome means staying healthy with your diet, and avoiding specific foods.

Eating Right