Current Clinical Trials

The approach to treatment often depends on the results of preoperative localization studies and findings at exploratory laparotomy. At exploration, 85% of these tumors are found in the gastrinoma triangle with 40% on the surface of the pancreas and 40% outside of the pancreas. Only 15% are found within the substance of the pancreas. Percutaneous transhepatic venous sampling may occasionally provide accurate localization of single sporadic gastrinomas. Total gastrectomy is no longer considered the immediate treatment of choice and is selectively used depending on effectiveness of other treatment programs.[1]

Standard treatment options:

1. Single lesion in head of the pancreas:
   • Enucleation.
   • Parietal cell vagotomy and cimetidine.
   • Total gastrectomy (in very unusual circumstances).
2. Single or multiple lesions in the duodenum:
   • Pancreatoduodenectomy.
3. Single lesion in body/tail of the pancreas:
   • Resection of body/tail.
4. Multiple lesions in pancreas:
   • Resection of body/tail and, if residual disease is present,
   • Parietal cell vagotomy and cimetidine, or
   • Total gastrectomy.
5. No tumor found:
   • Parietal cell vagotomy and cimetidine.
   • Total gastrectomy.
6. Liver metastases:
   • Liver resection where possible; radiofrequency ablation and cryosurgical ablation are options.
   • Chemoembolization of liver.
7. Metastatic disease or disease refractory to surgery and cimetidine:
   • Combination chemotherapy: doxorubicin plus streptozocin or fluorouracil plus streptozocin in patients when doxorubicin is contraindicated.[2]
   • Somatostatin analogue therapy (SMS 201-995).[3]

Patients with hepatic-dominant disease and substantial symptoms caused by tumor bulk or hormone-release syndromes may benefit from procedures that reduce hepatic arterial blood flow to metastases (hepatic arterial occlusion with embolization or with chemoembolization). Such treatment may also be combined with systemic chemotherapy in selected patients.[4] Treatment with proton pump inhibitors or H2 blocking agents may aid in control of peptic symptoms.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with gastrinoma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.

General information about clinical trials is also available from the NCI Web site.

References

1. Glowniak JV, Shapiro B, Vinik AI, et al.: Percutaneous transhepatic venous sampling of gastrin: value in sporadic and familial islet-cell tumors and G-cell hyperfunction. N Engl J Med 307 (5): 293-7, 1982.  [PUBMED Abstract]
   
   
2. Moertel CG, Lefkopoulo M, Lipsitz S, et al.: Streptozocin-doxorubicin, streptozocin-fluorouracil or chlorozotocin in the treatment of advanced islet-cell carcinoma. N Engl J Med 326 (8): 519-23, 1992.  [PUBMED Abstract]
   
   
3. Kvols LK, Buck M, Moertel CG, et al.: Treatment of metastatic islet cell carcinoma with a somatostatin analogue (SMS 201-995). Ann Intern Med 107 (2): 162-8, 1987.  [PUBMED Abstract]
   
   
4. Moertel CG, Johnson CM, McKusick MA, et al.: The management of patients with advanced carcinoid tumors and islet cell carcinomas. Ann Intern Med 120 (4): 302-9, 1994.  [PUBMED Abstract]
   
   

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