Treatment of gastrointestinal endocrine tumours with interferon-alpha and octreotide.

This paper reports on the results of two controlled therapeutic trials on patients with endocrine tumours of the gastrointestinal tract. Seventeen patients were treated up to 18 months with recombinant interferon-alpha 2c (2 x 10(6) IU/m2 s.c. daily) and 16 patients are treated in an ongoing study with octreotide (3 x 200 micrograms daily). Objective response (greater than 50% reduction of hormone secretion) was observed in one of 15 evaluable patients on IFN-alpha and in 12 of 16 patients on octreotide. Reduction of tumour size was not observed in these two trials. However, the majority of patients had stable tumour size during IFN-alpha and octreotide treatment despite progressive disease before. Subjective improvement due to reduction of symptoms such as flushing, diarrhea, and dermatitis was significantly more frequent after octreotide than after IFN-alpha. Of five endocrine tumour patients with progressive disease on IFN-alpha, three responded to subsequent treatment with octreotide while one had stable disease and one progressed. Two cases are reported from the authors' series of patients treated with octreotide before start of these trials. Complete remission of the tumour by low-dose (2 x 100 micrograms daily) octreotide was observed in one carcinoid patient. This remission has now lasted for four years. In one patient with liver metastasis of a VIPoma, who had become resistant to streptozotocin, his watery diarrhoea is now completely controlled with 100 micrograms octreotide s.c. every second day.

Long-term omeprazole treatment in man: effects on gastric endocrine cell populations.

36 patients with chronic gastric or oesophageal peptic ulceration (including 6 with antrectomy), resistant to high-dose ranitidine treatment for at least 3 months, were successfully treated with 40-60 mg of omeprazole daily for periods between 1 and 2 years. Fasting serum gastrin levels were monitored at regular intervals during therapy and multiple gastric mucosal biopsies were taken during gastroscopy every 3-6 months. Gastrin levels increased significantly during the first 6 months of therapy from a medium level of 81.5 to 206 pg/ml, a slight decrease was seen thereafter. In 10 patients investigated before the start of the treatment and after 1 and 2 years, the volume density of argyrophilic cells in the oxyntic mucosa increased from 0.43 +/- 0.08 to 0.91 +/- 0.14% during the first year; this change was statistically significant. No further increase was observed thereafter. No such difference could be demonstrated between a larger group of 18 patients investigated before and after 1 year of treatment with omeprazole (0.806 +/- 0.1 vs. 0.93 +/- 0.08%) and between a larger group of 22 untreated patients and 17 patients treated for 17-24 months with omeprazole (0.73 +/- 0.1 vs. 0.86 +/- 0.09%). The volume density of argyrophilic cells found in 8 patients with gastrinoma amounted to 1.37 +/- 0.22%. No clusters of endocrine cells were found in omeprazole-treated patients. The D cell volume density in the antral mucosa decreased significantly during the first months of treatment, but steadily increased thereafter to reach pretreatment values after 17 months. There was no change in G cell volume density under therapy. No changes in gastrin levels or oxyntic argyrophilic cells were observed in the antrectomized patients. It is concluded that the hyperplasia of argyrophilic cells observed in some patients during long-term omeprazole treatment is mediated by hypergastrinaemia.