Current Clinical Trials

Standard treatment options:

1. Single lesion in head of pancreas or single lesion less than 1.0 cm in tail of pancreas:
   • Enucleation, if feasible.
2. Single lesion in body/tail greater than 1.0 cm:
   • Distal pancreatectomy.
3. Multiple lesions: occur in 10%, suspect multiple endocrine neoplasia syndrome type 1 (MEN-1):
   • Resect body and tail.
4. Metastatic lesions-lymph nodes or distant sites:
   • Resect when possible. Consider radiofrequency or cryosurgical ablation if not resectable.
5. Unresectable:
   • Combination chemotherapy: doxorubicin plus streptozocin or fluorouracil plus streptozocin in patients when doxorubicin is contraindicated.[1,2]
   • Pharmacologic palliation: diazoxide 300 to 500 mg/day
   • Somatostatin analogue therapy (SMS 201-995).[3] Necrotizing erythema of glucagonoma is relieved in 24 hours with somatostatin analogue, with nearly complete disappearance within 1 week.

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]

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with insulinoma. 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. Danforth DN Jr, Gorden P, Brennan MF: Metastatic insulin-secreting carcinoma of the pancreas: clinical course and the role of surgery. Surgery 96 (6): 1027-37, 1984.  [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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