• Monoamine oxidase inhibitors such as procarbazine (Matulane) and tranylcypromine sulfate (Parnate) are
drugs to be avoided. They will exacerbate the carcinoid syndrome by inhibiting the breakdown of serotonin.
• Acute symptoms—carcinoid crisis—may be prevented and controlled by pretreatment with octreotide. Some
specific drugs are to be avoided in these patients because of the risk of causing the release of vasoactive
substances. This is especially true during surgery and in the treatment of low blood pressure.
Chemotherapy Although activity with a variety of single agents and drug combinations has been
reported—5-fluorouracil (5-FU), doxorubicin (Adriamycin) and dacarbazine (DTIC) or 5-FU + streptozocin—response rates seldom exceed 30 percent. Complete responses are uncommon, and the duration of the response may be short, if chemotherapy is used alone.
Chemotherapy should be used for palliation in patients with symptoms and in the case of liver metastases, after blocking the hepatic (liver) artery and then giving chemotherapy (chemoembolization).
Investigational
• Protocols using new drugs may be considered ( see "Recurrent Cancer" ). One study showed a three-fold
increase in survival of patients treated with octreotide compared to chemotherapy, but further studies are
needed to confirm results and prove that the improved survival is significant.
