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PubMed This is a summary of 28 peer-reviewed journal articles Updated
Oncology

The Treatment Path: Managing Symptoms and Growth

At a Glance

Carcinoid syndrome treatment aims to relieve hormone-related flushing and diarrhea while controlling the neuroendocrine tumors causing them. Monthly somatostatin analogs are a common foundation; telotristat, PRRT, or liver-directed treatment can be added when symptoms or tumor growth persist.

Managing Carcinoid Syndrome is a dual mission: your care team must work to control the hormone-driven symptoms that affect your daily life while also managing the growth of the underlying neuroendocrine tumors (NETs) [1][2]. Because the syndrome involves complex biology, treatment often follows a “step-up” approach, adding new tools as needed to keep you comfortable and stable [3][4]. Treatment and sequencing are highly individualized based on symptom severity, tumor site, and SSTR expression.

Medical Foundations: Somatostatin Analogs

For many patients with symptomatic carcinoid syndrome, the foundation of care is a class of drugs called Somatostatin Analogs (SSAs) [1]. These medications mimic a natural hormone in your body that “turns off” the release of other hormones like serotonin [5].

  • Long-Acting SSAs: Octreotide LAR and Lanreotide Depot are common options [1][6]. These are typically given as a monthly injection [7]. Their goal is twofold: to reduce flushing and diarrhea and to stabilize or slow down tumor growth [2][6].
  • Short-Acting “Rescue”: You may also be prescribed a short-acting version of octreotide [3]. This is a self-administered injection used to treat “breakthrough” symptoms—sudden episodes of flushing or diarrhea that happen between your monthly doses [8][9].
    (Note: SSAs can cause side effects like gallbladder disease, glucose changes, and fat-absorption issues (Pancreatic Exocrine Insufficiency), which require ongoing monitoring.)

Targeting Persistent Diarrhea: Telotristat Ethyl

If you are already on an SSA but still experience inadequately controlled diarrhea (often evaluated as four or more bowel movements a day), your doctor may evaluate adding telotristat ethyl (Xermelo) [10][11].

Unlike SSAs, which stop the release of hormones, telotristat ethyl works by blocking the production of serotonin inside the tumor cells [12]. Research has shown that adding this pill to SSA therapy can significantly reduce the frequency of diarrhea [10][13]. Clinicians should also consider other contributors to diarrhea like infection or malabsorption. Telotristat can cause constipation and liver-test abnormalities, requiring monitoring.

Systemic Therapy: PRRT (Lutathera)

When tumors continue to grow or symptoms remain uncontrolled despite standard therapy in appropriately selected, advanced, SSTR-positive patients, Peptide Receptor Radionuclide Therapy (PRRT) may be used [14][15]. The most common form is Lutathera (177Lu-DOTATATE) [14].

PRRT is a form of “targeted radiation” [14]. A radioactive molecule is attached to a protein that seeks out and sticks to the receptors on the surface of your NET cells [16]. This delivers radiation directly to the tumor [14]. While its primary job is tumor control, many patients also see a significant reduction in their syndrome symptoms after treatment [17][18]. Eligibility requires assessment of renal, liver, and marrow function, as risks include kidney injury and uncommon delayed myelodysplastic syndrome or leukemia.

Local Action: Liver-Directed Therapies

Since Carcinoid Syndrome is often driven by tumors in the liver, treating those specific spots can offer major relief [19][20].

  • Embolization (TAE/TACE): A procedure where a doctor threads a catheter into the liver and blocks the blood supply to the tumors, sometimes adding chemotherapy (TACE) [21][22].
  • Ablation: Using extreme heat or cold to “burn” or “freeze” individual tumor spots [23][24].
  • Cytoreductive Surgery: “Debulking” or removing as much of the tumor as possible to reduce the overall hormone-producing mass [19].

Monitoring and Long-Term Success

Because these treatments can have side effects, regular monitoring is essential [25][26]. Your team will use a combination of physical exams, symptom logs, and laboratory tests (like 5-HIAA or Chromogranin A) to ensure your treatment plan is working and to make adjustments as your needs change [25][27][28].

Common questions in this guide

Which medicines are usually used to control carcinoid syndrome symptoms?
Long-acting somatostatin analogs, such as octreotide LAR or lanreotide depot, are commonly used to reduce flushing and diarrhea and may help slow tumor growth. A short-acting octreotide injection may be prescribed for sudden breakthrough symptoms between monthly doses.
Could telotristat help if I still have diarrhea on my injections?
A clinician may add telotristat ethyl, also called Xermelo, when diarrhea remains inadequately controlled despite a somatostatin analog, often when there are four or more bowel movements a day. Infection, malabsorption, and other causes should also be considered, and possible side effects include constipation and abnormal liver tests.
Who might be eligible for PRRT with Lutathera?
PRRT with Lutathera may be considered for selected people with advanced, somatostatin-receptor-positive neuroendocrine tumors when tumors grow or symptoms remain uncontrolled despite standard treatment. The care team checks kidney, liver, and bone-marrow function because PRRT can injure the kidneys and rarely cause delayed bone-marrow disorders or leukemia.
How can treating liver tumors affect carcinoid syndrome?
When liver tumors contribute to hormone release, liver-directed treatments may reduce the amount of tumor producing those hormones and improve symptoms. Options can include blocking the tumors’ blood supply, sometimes with chemotherapy, using heat or cold to destroy individual tumors, or surgery to remove as much tumor as possible.
What monitoring is needed during carcinoid syndrome treatment?
Your care team may track your symptoms, physical examination findings, scans, and laboratory markers such as 5-HIAA and chromogranin A. Monitoring also looks for treatment effects, including gallbladder disease, glucose changes, digestion problems, liver-test abnormalities, kidney injury, and changes in blood counts.
What side effects should I watch for with somatostatin analogs?
Somatostatin analogs can be associated with gallbladder disease, changes in blood glucose, and problems absorbing fat. Tell your care team about oily stools, weight loss, or other new digestive symptoms so they can check for pancreatic exocrine insufficiency and adjust treatment if needed.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Is my current SSA dose optimized, or could increasing the frequency or dose help my breakthrough flushing?
  2. 2.Given my daily diarrhea frequency, am I a candidate to add telotristat ethyl, or should we consider other causes first?
  3. 3.Do my latest scans show that my tumors express SSTR receptors, making me a candidate for PRRT (Lutathera)?
  4. 4.If we consider liver-directed therapy, would TAE, TACE, or ablation be more appropriate for my specific tumor distribution?
  5. 5.What is the plan to monitor for long-term side effects, such as gallbladder issues or changes in my blood counts?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (28)
  1. 1

    Efficacy, safety and unmet needs of evolving medical treatments for carcinoid syndrome.

    Koumarianou A, Daskalakis K, Tsoli M, et al.

    Journal of neuroendocrinology 2022; (34(7)):e13174 doi:10.1111/jne.13174.

    PMID: 35794780
  2. 2

    Octreotide and Lanreotide in Gastroenteropancreatic Neuroendocrine Tumors.

    Pokuri VK, Fong MK, Iyer R

    Current oncology reports 2016; (18(1)):7 doi:10.1007/s11912-015-0492-7.

    PMID: 26743514
  3. 3

    Management of carcinoid syndrome: a systematic review and meta-analysis.

    Hofland J, Herrera-Martínez AD, Zandee WT, de Herder WW

    Endocrine-related cancer 2019; (26(3)):R145-R156.

    PMID: 30608900
  4. 4

    Carcinoid Syndrome: Updates and Review of Current Therapy.

    Oleinikov K, Avniel-Polak S, Gross DJ, Grozinsky-Glasberg S

    Current treatment options in oncology 2019; (20(9)):70 doi:10.1007/s11864-019-0671-0.

    PMID: 31286272
  5. 5

    Perspectives on the current pharmacotherapeutic strategies for management of functional neuroendocrine tumor syndromes.

    Ito T, Jensen RT

    Expert opinion on pharmacotherapy 2021; (22(6)):685-693 doi:10.1080/14656566.2020.1845651.

    PMID: 33131345
  6. 6

    EVALUATION OF LANREOTIDE DEPOT/AUTOGEL EFFICACY AND SAFETY AS A CARCINOID SYNDROME TREATMENT (ELECT): A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL.

    Vinik AI, Wolin EM, Liyanage N, et al.

    Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists 2016; (22(9)):1068-80 doi:10.4158/EP151172.OR.

    PMID: 27214300
  7. 7

    Analysis of Real-World Treatment Patterns, Healthcare Resource Utilization, and Costs Between Octreotide and Lanreotide Among Patients With Neuroendocrine Tumors.

    Huynh L, Cai B, Cheng M, et al.

    Pancreas 2019; (48(9)):1126-1135 doi:10.1097/MPA.0000000000001403.

    PMID: 31593022
  8. 8

    Gastrointestinal neuroendocrine tumors treated with high dose octreotide-LAR: a systematic literature review.

    Broder MS, Beenhouwer D, Strosberg JR, et al.

    World journal of gastroenterology 2015; (21(6)):1945-55 doi:10.3748/wjg.v21.i6.1945.

    PMID: 25684964
  9. 9

    BIOCHEMICAL RESPONSES IN SYMPTOMATIC AND ASYMPTOMATIC PATIENTS WITH NEUROENDOCRINE TUMORS: POOLED ANALYSIS OF 2 PHASE 3 TRIALS.

    Mirakhur B, Pavel ME, Pommier RF, et al.

    Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists 2018; doi:10.4158/EP-2018-0296.

    PMID: 30084687
  10. 10

    Telotristat Ethyl, a Tryptophan Hydroxylase Inhibitor for the Treatment of Carcinoid Syndrome.

    Kulke MH, Hörsch D, Caplin ME, et al.

    Journal of clinical oncology : official journal of the American Society of Clinical Oncology 2017; (35(1)):14-23 doi:10.1200/JCO.2016.69.2780.

    PMID: 27918724
  11. 11

    TELEPRO: Patient-Reported Carcinoid Syndrome Symptom Improvement Following Initiation of Telotristat Ethyl in the Real World.

    Strosberg J, Joish VN, Giacalone S, et al.

    The oncologist 2019; (24(11)):1446-1452 doi:10.1634/theoncologist.2018-0921.

    PMID: 31189618
  12. 12

    Telotristat Ethyl: A Review in Carcinoid Syndrome Diarrhoea.

    Lyseng-Williamson KA

    Drugs 2018; (78(9)):941-950 doi:10.1007/s40265-018-0935-1.

    PMID: 29931594
  13. 13

    Time to Sustained Improvement in Bowel Movement Frequency with Telotristat Ethyl: Analyses of Phase III Studies in Carcinoid Syndrome.

    Dillon JS, Kulke MH, Hörsch D, et al.

    Journal of gastrointestinal cancer 2021; (52(1)):212-221 doi:10.1007/s12029-020-00375-2.

    PMID: 32146619
  14. 14

    Lutathera®: The First FDA- and EMA-Approved Radiopharmaceutical for Peptide Receptor Radionuclide Therapy.

    Hennrich U, Kopka K

    Pharmaceuticals (Basel, Switzerland) 2019; (12(3)) doi:10.3390/ph12030114.

    PMID: 31362406
  15. 15

    Symptom Diaries of Patients with Midgut Neuroendocrine Tumors Treated with 177Lu-DOTATATE.

    Strosberg JR, Srirajaskanthan R, El-Haddad G, et al.

    Journal of nuclear medicine : official publication, Society of Nuclear Medicine 2021; (62(12)):1712-1718 doi:10.2967/jnumed.120.258897.

    PMID: 33771903
  16. 16

    Peptide Receptor Radionuclide Therapy for Patients With Advanced Lung Carcinoids.

    Naraev BG, Ramirez RA, Kendi AT, Halfdanarson TR

    Clinical lung cancer 2019; (20(3)):e376-e392 doi:10.1016/j.cllc.2019.02.007.

    PMID: 30910575
  17. 17

    Peptide Receptor Radionuclide Therapy With 177Lu-DOTATATE for Symptomatic Control of Refractory Carcinoid Syndrome.

    Zandee WT, Brabander T, Blažević A, et al.

    The Journal of clinical endocrinology and metabolism 2021; (106(9)):e3665-e3672 doi:10.1210/clinem/dgab289.

    PMID: 33942075
  18. 18

    Systemic Treatment Options for Carcinoid Syndrome: A Systematic Review.

    Wolin EM, Benson Iii AB

    Oncology 2019; (96(6)):273-289 doi:10.1159/000499049.

    PMID: 31018209
  19. 19

    Liver-Directed Therapy for Neuroendocrine Tumor Metastases in the Era of Peptide Receptor Radionuclide Therapy.

    Rabei R, Fidelman N

    Current treatment options in oncology 2023; (24(12)):1994-2004 doi:10.1007/s11864-023-01152-6.

    PMID: 38100020
  20. 20

    [Radiologically guided interventional therapies for the treatment of neuroendocrine tumors].

    Radosa CG, Nebelung H, Schön F, Hoffmann RT

    Radiologie (Heidelberg, Germany) 2024; (64(7)):575-581 doi:10.1007/s00117-024-01314-z.

    PMID: 38761204
  21. 21

    Comparison of transarterial bland and chemoembolization for neuroendocrine tumours: a systematic review and meta-analysis.

    Tai E, Kennedy S, Farrell A, et al.

    Current oncology (Toronto, Ont.) 2020; (27(6)):e537-e546 doi:10.3747/co.27.6205.

    PMID: 33380868
  22. 22

    Hepatic artery embolization in advanced neuroendocrine tumors: Efficacy and long-term outcomes.

    Pericleous M, Caplin ME, Tsochatzis E, et al.

    Asia-Pacific journal of clinical oncology 2016; (12(1)):61-9 doi:10.1111/ajco.12438.

    PMID: 26663886
  23. 23

    Liver metastases of neuroendocrine tumors: Conventional transarterial chemoembolization and thermal ablation.

    Vogl TJ, Gruber-Rouh T, Naguib NNN, et al.

    RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin 2024; (196(4)):381-389 doi:10.1055/a-2193-0722.

    PMID: 38109897
  24. 24

    CAN MICROWAVE ABLATION BE AN ALTERNATIVE TO RESECTION FOR THE TREATMENT OF NEUROENDOCRINE LIVER METASTASES?

    Perrodin SF, Renzulli MM, Maurer MH, et al.

    Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists 2020; (26(4)):378-387 doi:10.4158/EP-2019-0394.

    PMID: 31859556
  25. 25

    Long-Acting Somatostatin Analogue Safety Monitoring Protocol for Outpatients With Neuroendocrine Tumors.

    Gabrielsen J, Girone G, Bennett B, Jung A

    Journal of the advanced practitioner in oncology 2019; (10(7)):646-659 doi:10.6004/jadpro.2019.10.7.2.

    PMID: 33391850
  26. 26

    Persistent Hematologic Dysfunction after Peptide Receptor Radionuclide Therapy with 177Lu-DOTATATE: Incidence, Course, and Predicting Factors in Patients with Gastroenteropancreatic Neuroendocrine Tumors.

    Bergsma H, van Lom K, Raaijmakers MHGP, et al.

    Journal of nuclear medicine : official publication, Society of Nuclear Medicine 2018; (59(3)):452-458 doi:10.2967/jnumed.117.189712.

    PMID: 28775205
  27. 27

    Association between neuroendocrine tumors biomarkers and primary tumor site and disease type based on total 68Ga-DOTATATE-Avid tumor volume measurements.

    Tirosh A, Papadakis GZ, Millo C, et al.

    European journal of endocrinology 2017; (176(5)):575-582.

    PMID: 28289088
  28. 28

    Patient-Reported Symptom Control of Diarrhea and Flushing in Patients with Neuroendocrine Tumors Treated with Lanreotide Depot/Autogel: Results from a Randomized, Placebo-Controlled, Double-Blind and 32-Week Open-Label Study.

    Fisher GA, Wolin EM, Liyanage N, et al.

    The oncologist 2018; (23(1)):16-24 doi:10.1634/theoncologist.2017-0284.

    PMID: 29038234

This page explains carcinoid syndrome treatment options for informational purposes only and does not replace medical advice. Your care team can help choose and monitor treatment for your symptoms and tumors.

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