Are there recommendations on how to convert octreotide SQ/IV to lanreotide?

Are there recommendations on how to convert octreotide SQ/IV to lanreotide?

Comment by InpharmD Researcher

There appears to be no validated dose conversion between octreotide and lanreotide. However, a Korean Endocrine Society position statement on acromegaly provides guidance for switching between somatostatin analogues; experts recommend initiating lanreotide at its standard doses (60, 90, or 120 mg every 4 weeks) regardless of prior octreotide exposure, followed by biochemical monitoring and dose titration based on response. Retrospective data suggest broadly comparable efficacy between agents, but interpatient variability may preclude any fixed equivalence.

Background

A 2019 position statement by the Korean Endocrine Society (KES) outlined expert consensus on the use of somatostatin analogues for the medical management of acromegaly. The statement was developed in response to an increasing number of cases and a growing body of literature addressing pharmacological interventions, with recommendations formulated based on a comprehensive review of available evidence and expert voting where consensus was lacking. The document detailed the biochemical and clinical indications for initiating somatostatin analogue therapy, dosing strategies, switching protocols, prolonged dosing intervals, and special considerations, including preoperative use and hyperglycemia management. Octreotide long-acting release (LAR) was recommended at an initial dose of 20 mg every four weeks, with dose escalation to 30 mg or 40 mg based on biochemical response. Lanreotide autogel (ATG) was advised at starting doses of 60, 90, or 120 mg every four weeks, with the possibility of extending the dosing interval to eight weeks in well-controlled patients. Pasireotide LAR was introduced as an alternative for cases unresponsive to other analogues, albeit with a noted risk of hyperglycemia. [1]

The position statement also addressed therapeutic adjustments, including the rationale for switching between octreotide LAR and lanreotide ATG based on biochemical control and tolerability. When transitioning between somatostatin analogues, the new agent should be initiated at its standard starting dose. Specifically, when switching from octreotide LAR to lanreotide ATG, a dose of 60, 90, or 120 mg may be used regardless of the previous octreotide LAR dosage. Serum growth hormone (GH) levels should be monitored regularly during the first 3 months of treatment. If GH levels remain >2.5 μg/L, dose escalation may be considered to achieve optimal biochemical control. A retrospective analysis cited within the document suggested that both agents exhibit comparable efficacy in suppressing GH and insulin-like growth factor-1 (IGF-1) levels, though individual responses may necessitate changes in therapy. Overall, the authors suggest that switching to a different somatostatin analogue may be beneficial if treatment goals are not met or if intolerable adverse effects occur. [1]

Literature Review

A search of the published medical literature revealed 1 study investigating the researchable question:

Are there recommendations on how to convert octreotide SQ/IV to lanreotide?

Level of evidence

D - Case reports or unreliable data Read more→

Please see Table 1 for your response.

Medical record review of transition to lanreotide following octreotide for neuroendocrine tumors
Design	Multicenter, noninterventional, retrospective medical record review N= 91
Objective	To evaluate clinical outcomes among patients with gastroenteropancreatic neuroendocrine tumors (GEP-NET) who transitioned from long-acting octreotide monotherapy to lanreotide monotherapy in routine clinical practice
Study Groups	All patients (n= 91)
Inclusion Criteria	Patients aged 18 years or older with a confirmed diagnosis of locally advanced or metastatic GEP-NET who sequenced treatment from long-acting octreotide to lanreotide, treated with octreotide for at least 90 days before transitioning to lanreotide and continued on lanreotide for at least 90 days
Exclusion Criteria	Patients enrolled in a clinical trial for GEP-NET, with a history of other malignant disease (except basal cell carcinoma or carcinoma in situ of the cervix), treated with an SSA in combination with NET treatments other than immediate release subcutaneous octreotide, received other primary treatment for GEP-NET, or had a familial NET syndrome
Methods	Data were abstracted from medical records of patients treated with long-acting octreotide followed by lanreotide. Clinically defined progression-free survival (PFS) and other tumor-related outcomes were assessed. Statistical analyses were descriptive, and PFS was estimated using the Kaplan-Meier method
Duration	Data collection from April 2017 to October 2017
Outcome Measures	Primary: Clinician-defined progression-free survival (PFS) following transition to lanreotide Secondary: Duration of treatment with lanreotide, disease stabilization
Baseline Characteristics	Characteristic	All patients (n= 91)
	Sex - Female	54 (59.3%)
	Race - White	83 (91.2%)
	Race - Black/African American	5 (5.5%)
	Age at diagnosis, mean (SD), years	57.7 (10.9)
	Stage IV at initial diagnosis	65 (71.4%)
	Primary tumor site - Small intestine	58 (63.7%)
	Primary tumor site - Pancreas	13 (14.3%)
	Site of metastases - Liver	65 (71.4%)
	Tumor histology - Well-differentiated	62 (68.1%)
	Functional status - Functional	55 (60.4%)
Results	Progression-free survival (months)	All patients
	Median (95% CI)	23.7 (20.2 to not evaluable)
	Nonprogressive disease at transition	24.7 (17.0 to not evaluable)
	Progressive disease at transition	15.2 (11.4 to not evaluable)
Adverse Events	There were no material differences in adverse events recorded during the long-acting octreotide and lanreotide treatment periods
Study Author Conclusions	Lanreotide monotherapy is well tolerated and may contribute to stabilization of disease in a subset of patients with locally advanced or metastatic gastroenteropancreatic NETs previously treated with long-acting octreotide.
Critique	The study provides valuable real-world data on the transition from octreotide to lanreotide, showing potential benefits in disease stabilization. However, the retrospective design and reliance on medical record data may introduce biases and limit the generalizability of the findings. The lack of formal criteria for disease progression assessment could affect the consistency of the results.

References:
[1] [1] Saif MW, Parikh R, Ray D, et al. Medical record review of transition to lanreotide following octreotide for neuroendocrine tumors. J Gastrointest Oncol. 2019;10(4):674-687. doi:10.21037/jgo.2019.03.11