Treatment Standard treatment is surgery to remove the entire tumor where possible and reduce (debulk) any metastases. In gastrointestinal tumors this will involve resection of the affected area. For bronchial (airway) lesions, procedures such as lobectomy, sleeve resection or pneumonectomy may be required depending on the location of the mass. Debulking of liver metastases can be done by surgical excision or by newer techniques such as cryoablation and radiofrequency ablation. Hepatic artery catheterization with injection of embolic inert particles alone or mixed with chemotherapy has been very effective in many patients with liver metastases. The chemotherapeutic drugs injected in this treatment are cisplatin, mitomycin, and doxorubicin. Systemic chemotherapy is also used with an overall beneficial response in approximately one third of the patients. Drugs used for this purpose include dacarbazine, VP-16 (etoposide), cisplatin, doxorubicin, 5-fluorouracil, streptozotocin and cyclophosphamide. Some newer agents are currently being investigated. Once the tumors have been removed, periodic long-term surveillance is required.
Octreotide (Sandostatin) injections are the mainstay for symptomatic management of carcinoid syndrome. Octreotide is a synthetic form of the pancreatic hormone, somatostatin, and it may be administered in three to four subcutaneous injections per day, one long-acting intramuscular injection every three or four weeks, or by continuous infusion with a sub-cutaneous pump. Sometimes, it is combined with injection of low-dose alpha interferon, which enhances the body’s response.
In 2017, Xermelo (telotriastat ethyl) tablets in combination with somatostatin analog (SSA) therapy was FDA approved for the treatment of adults with carcinoid syndrome diarrhea that SSA therapy alone inadequately controls. Xermelo is manufactured by Lexicon Pharmaceuticals, Inc.
Various nutritional products are available and may be useful, as may anti-diarrheal and anti-cholinergic medications. Patients are often advised to avoid certain substances such as alcohol and foods with a high concentration of tyramine, as these may make symptoms worse.