Best Practices for the Management of Neuroendocrine Tumors - Episode 9
Practice Pearl 2: Various Preparations and Delivery Systems of Somatostatin Analogues for NETs
Experts in the management of NETs review the various delivery systems and preparations available for short- and long-acting somatostatin analogues.
Daneng Li, MD: We know—and you’ve highlighted, Megan—that there might be differences in terms of the preparation of these somatostatin analogues [SSAs]. In addition to the long-acting somatostatin analogues that we have mentioned, maybe say something about the short-acting somatostatin analogue therapy as well.
Cecilia, could you comment on the various delivery systems that are used for somatostatin analogue therapy? Whether it’s long-acting somatostatin analogues or short-acting somatostatin analogues, ultimately how will that potentially impact a patient in terms of their life on a daily basis?
Cecilia Lau, RPh, BCOP, APh: For the short-acting octreotide, it comes in a number of formats. Originally, it was available in vials, either single dose or multidose. Patients need to learn how to not only give themselves an injection but also draw up the injection—the necessary dose from the vial—change needles, and give themselves the injection. Later on, the short-acting octreotide was also available as prefilled syringes at a few doses, such as 50 µg, 100 µg, and 500 µg.
That saved the patient the hassle of drawing up the syringe themselves, but they still have to give themselves injection. If a patient needs dose titration or a dose increase, having the prefilled syringe may be a slight disadvantage because the patient might actually end up having to use more than 1 syringe for each dose. These are not the most patient-friendly delivery systems. Both the vials and the prefilled syringes require refrigeration at all times. For patients who go to work or will be out for a prolonged period, they need to have an ice pack or an ice chest with them.
A few months ago, short-acting octreotide became available in a pen-delivery system. The idea is very similar to an insulin pen, wherein the pen is calibrated to deliver preset doses. This pen is calibrated to deliver 50-, 100-, 150-, or 200-µg doses. If a patient is still having a dose titrated, they just change the dial on the pen, and this becomes an easy administration for them.
Each pen comes in a pack of 2 and contains 2.8 mL of concentrated octreotide at 2500 µg/mL. The unused pen does require refrigeration. However, upon the first dose, the pen can then be stored at room temperature for up to 28 days. So this becomes a major factor in patient convenience because the pen becomes very easily portable. The patient can just stick it in a purse or a backpack without an ice pack.
As far as the long-acting octreotide, Megan touched on it already. There is the subcutaneous vs the IM [intramuscular] injection. There is the preparation time in the pharmacy, and for the octreotide-LAR [long-acting release], once it’s reconstituted in the pharmacy and gets to the hands of the nurse, the nurse basically has to go everywhere with their arm moving still to make sure the drug stays in suspension and does not clog up because then it turns into a semi-cement block that cannot be administered anymore. It can also clog up the needle. That makes it more painful for the patient upon administration.
Daneng Li, MD: That is a very good summary in terms of long acting or short acting. I am really enthusiastic to hear that we are making headways in terms of improving the quality of life for patients in terms of how they are administering short-acting octreotide for themselves at home with the octreotide-acetate pen. That pen really helps make it a little easier at home in terms of the injection on a daily basis, in addition to the different mechanisms and delivery systems that we have been able to improve on for the long-acting somatostatin analogue therapy that we are used to.