SPINET
SPINET tried to prove that the somatostatin analogue lanreotide slows lung carcinoid tumours, as it does gut tumours, but recruited too few patients to give a definitive answer; the small comparison favoured the drug and it is used on that basis.
Overview
Somatostatin analogues are the first-line treatment for advanced gut and pancreatic neuroendocrine tumours on the strength of the PROMID and CLARINET trials, but their use in lung carcinoids rested on extrapolation. SPINET randomised patients with somatostatin-receptor-positive, well-differentiated typical or atypical lung neuroendocrine tumours to lanreotide autogel 120 mg or placebo, with progression-free survival as the primary endpoint.
Recruitment was slow and the trial closed early with 77 patients, well short of its target. In the reduced population progression-free survival was longer with lanreotide than with placebo, in line with the gut trials, but the trial was underpowered for a formal conclusion. Guidelines still recommend somatostatin analogues for receptor-positive lung carcinoids on this and the gut evidence.
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