VIPoma medical therapy

Initial treatment in patient with VIPoma is prompt replacement of fluid and correction of electrolyte imbalance and acid-base disturbance. Somatostatin analogues like short acting octreotide is useful for controlling diarrhea by blocking the release of VIP. Octreotide is later replaced by longer acting depot preparation of somatostatin analogues like sandostatin or lanreotide.

• Initial treatment in patient with VIPoma is prompt replacement of fluid and electrolyte losses.
• The IV fluid of choice is isotonic normal saline with added potassium and bicarbonate as necessary.

• Somatostatin analogues like short acting octreotide is useful for controlling diarrhea by blocking the release of VIP.^[1]
• Octreotide is later replaced by longer acting depot preparation of somatostatin analogues like sandostatin or lanreotide.
• Steroids are used in diarrhea of VIPoma refractory to somatostatin.
• Initial Management
  • Preferred regimen (1) : Octreotide 50-100mcg q8h initially
• Maintenance dosage
  • Preferred regimen (1): Sandostatin 20 mg IM every 4 weeks Lanreotide (120mg subcutaneously every 4 weeks). (OR)
  • Preferred regimen (2): Lanreotide 120mg subcutaneously every 4 weeks.
• Refractory cases
  • Preferred regimen (1): Prednisone 60 mg IM q24 for 1 week.
  • Preferred regimen (2): Sunitinib 37.5 mg PO q24h.

• There has been limited use of chemotherapy in patients with VIPoma. However, streptozocin based chemotherapy is considered best in the management of advanced local or metastatic disease.^[2][3][4][5]
• Most successful and favourable combination regimen of chemotherapy is streptozocin with doxorubicin together with somatostatin analogues.
• 5-FU can be used as alternative to doxorubicin in patients with who have contraindications to doxorubucin.
• Sunitinib (37.5 mg oral once a day) a tyrosin kinase inhibitor has some evidence of symptomatic and biochemical control in somatostatin analogue resistant VIPoma.
• Other molecular targeted therapy undergoing research for treatment are Everolimus (mTOR inhibitor) and Bevacizumab ( anti-VEGF monoclonal antibody).

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