Insulinoma medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2]

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Overview

Medical therapy is reserved for those who are unable to undergo the primary surgical therapy. Drugs commonly used for benign insulinoma are diazoxide, octreotide/lanreotide, phenytoin, verapamil and everolimus. For malignant insulinoma, these drugs are used with the chemotherapy drugs streptozocin, 5 fluorouracil, doxorubicin, bevacizumab and capecitabine in different combinations. For metastasis mainly going to liver regimens include hepatic artery embolization, radiation, chemo-embolization, ethanol ablation, radiofrequency ablation, and cryoablation.

Medical Therapy

Benign Insulinoma

1. Adult

  • 1.1 Parenteral
    • Preferred regimen (1): Octreotide 30 mg IM (depot) every 4 weeks until tumor progression or death.
    • Preferred regimen (2): Octreotide 100-500 μg SQ q 8-12h(can be increased to maximum 1500 μg daily)for 1 year.
    • Preferred regimen (3): Lanreotide 120 mg SQ every 4 weeks until tumor progression.
  • 1.2 Oral
    • Preferred regimen : Diazoxide 3-8 mg/kg OR 200-300 mg PO q8h for 14-21 days (1200 mg max to be divided in 3 doses and max is 400 mg/dose).[1][2]
    • Alternative regimen (1): Phenytoin 300-600 mg PO q daily. [3]
    • Alternative regimen (2): Everolimus 10 mg PO q daily until disease progression.
    • Verapamil and Propranolol to control symptoms are used either as alone or in combination.
    • Glucocorticoids and glucagon have been used in combination with diazoxide.

2. Pediatric

  • 2.1 Neonates and Infants:
    • 2.1.1 Oral
      • Preferred regimen: Diazoxide
        • Initial dose: 10 mg/kg/day divided into 3 equal doses q 8 hours.
        • Maintenance dosing range: 8 to 15 mg/kg/day divided into 2 or 3 equal doses every 8 to 12 hours.

Malignant (metastatic) Insulinoma

1. Chemotherapy
It is used in the different combination of the following drugs:

2. Liver-directed therapy (for metastasis)

References

  1. Goode PN, Farndon JR, Anderson J, Johnston ID, Morte JA (1986). "Diazoxide in the management of patients with insulinoma". World J Surg. 10 (4): 586–92. PMID 3019020.
  2. Gill GV, Rauf O, MacFarlane IA (1997). "Diazoxide treatment for insulinoma: a national UK survey". Postgrad Med J. 73 (864): 640–1. PMC 2431498. PMID 9497974.
  3. 3.0 3.1 Mathur, Aarti; Gorden, Philip; Libutti, Steven K. (2009). "Insulinoma". Surgical Clinics of North America. 89 (5): 1105–1121. doi:10.1016/j.suc.2009.06.009. ISSN 0039-6109.

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