Octreotide long-acting repeatable use among elderly patients with carcinoid syndrome and survival outcomes: a population-based analysis

Cancer. 2014 Jul 1;120(13):2039-49. doi: 10.1002/cncr.28653. Epub 2014 Mar 26.


Background: Octreotide long-acting repeatable (LAR) is indicated for the treatment of carcinoid syndrome and diarrhea related to VIPoma, and may delay tumor growth in patients with neuroendocrine tumors (NETs). To the authors' knowledge, the pattern of octreotide LAR use in clinical practice and its impact on survival outcomes has not been well documented.

Methods: Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, the authors identified patients with NET aged ≥ 65 years who were diagnosed between July 1999 and December 2007. Patients with US Food and Drug Administration-approved indications for octreotide LAR were identified from Medicare claims. Multivariate logistic regression was performed to ascertain factors associated with octreotide LAR use, whereas the Cox proportional hazards model was used to evaluate the impact of octreotide LAR on survival.

Results: Among those with Food and Drug Administration-approved indications, 245 of 4848 patients with distant-stage disease (51%) and 81 of 807 patients with local/regional disease (10%) initiated treatment with octreotide LAR within 6 months of diagnosis. Multivariate logistic regression indicated that among those with distant-stage disease, older age (≥ 80 years vs 65-69 years) (odds ratio [OR], 0.43; 95% confidence interval [95% CI], 0.23-0.81), female sex (OR, 0.62; 95% CI, 0.40-0.97), and living in the South (vs Northeast) (OR, 0.36; 95% CI, 0.18-0.72) were associated with a lower likelihood of using octreotide LAR. The multivariate proportional hazards model showed that octreotide LAR provided a significant 5-year survival benefit for patients with distant-stage disease (hazards ratio, 0.61; P ≤ .001), whereas this survival benefit was not shown for the patients with local/regional stage (hazards ratio, 0.88; P = .563).

Conclusions: The results of this retrospective study suggest a possible survival benefit for the use of octreotide LAR in elderly patients with distant-stage NET with carcinoid syndrome. The results of the current study also suggest that octreotide LAR is underused in this population despite recommended guidelines.

Keywords: Epidemiology; Surveillance; and End Results (SEER)-Medicare; health services for the aged; malignant carcinoid syndrome; neuroendocrine tumors; octreotide; somatostatin analog.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Antineoplastic Agents, Hormonal / administration & dosage
  • Antineoplastic Agents, Hormonal / adverse effects
  • Antineoplastic Agents, Hormonal / therapeutic use*
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Comorbidity
  • Confounding Factors, Epidemiologic
  • Drug Administration Schedule
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Malignant Carcinoid Syndrome / drug therapy*
  • Malignant Carcinoid Syndrome / ethnology
  • Malignant Carcinoid Syndrome / mortality*
  • Malignant Carcinoid Syndrome / pathology
  • Medicare
  • Neoplasm Grading
  • Neuroendocrine Tumors / drug therapy
  • Neuroendocrine Tumors / mortality
  • Octreotide / administration & dosage
  • Octreotide / adverse effects
  • Octreotide / therapeutic use*
  • Pancreatic Neoplasms / drug therapy
  • Pancreatic Neoplasms / mortality
  • Proportional Hazards Models
  • Retrospective Studies
  • SEER Program
  • Treatment Outcome
  • United States / epidemiology
  • Vipoma / drug therapy
  • Vipoma / mortality


  • Antineoplastic Agents, Hormonal
  • Octreotide