When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.
This Medical Policy Bulletin document describes the status of medical technology at the time the document was developed. Since that time, new technology may have emerged or new medical literature may have been published. This Medical Policy Bulletin will be reviewed regularly and be updated as scientific and medical literature becomes available. For more information on how Medical Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.
Brunton LL, Lazo JS, Parker KL. Goodman & Gilman’s The Pharmacological Basis of Therapeutics. 11th ed. 2006;1496-98.
Chadha MK, Lombardo J, Mashtare T, et al. High-dose octreotide acetate for management of gastroenteropancreatic neuroendocrine tumors. Anticancer Res. 2009;29(10):4127-30.
Chamberlain MC, Glantz MJ, Fadul CE. Recurrent meningioma: salvage therapy with long-acting somatostatin analogue. Neurology. 2007;69(10):969-73.
Colao A, Faggiano A, Pivonello R. Somatostatin analogues: treatment of pituitary and neuroendocrine tumors. In: L. Martini, eds. Prog Brain Res. 2010;182:281-94.
Colao A, Pivonello R, Auriemma RS, Galdiero M, Savastano S, Lombardi G. Beneficial effect of dose escalation of octreotide-LAR as first-line therapy in patients with acromegaly. Eur J Endocrinol. 2007;157(5):579-87.
Dipiro JT, Talbert RL, Yee GC, et al. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. 2011;626-27, 1349-50.
Elsevier’s Clinical Pharmacology Compendium. Octreotide acetate. [ClinicalKey Web site]. 01/31/2020. Available at: https://www.clinicalkey.com/pharmacology/ [via subscription only]. Accessed March 31, 2020.
Fleseriu M. Clinical efficacy and safety results for dose escalation of somatostatin receptor ligands in patients with acromegaly: a literature review. Pituitary. 2011;14(2):184-93.
Freda PU, Katznelson L, van der Lely AJ, et al. Long-acting somatostatin analog therapy of acromegaly: a meta-analysis. J Clin Endocrinol Metab. 2005;90(8):4465-73.
Giustina A, Bonadonna S, Bugari G, et al. High-dose intramuscular octreotide in patients with acromegaly inadequately controlled on conventional somatostatin analogue therapy: a randomised controlled trial. Eur J Endocrinol. 2009;161(2):331-8.
Lexi-Drugs Compendium. Octreotide acetate. [Lexicomp Online Web site]. 03/09/2020. Available at: http://online.lexi.com/lco/action/home [via subscription only]. Accessed March 31, 2020.
Ludlam WH, Anthony L. Safety review: dose optimization of somatostatin analogs in patients with acromegaly and neuroendocrine tumors. Adv Ther. 2011;28(10):825-41.
Medscape Reference: Drugs, Diseases, and Procedures. octreotide. Sandostatin LAR. 2020. Available at: http://reference.medscape.com/drug/sandostatin-lar-octreotide-342836#10 . Accessed April 1, 2020.
Melmed S, Katznelson L. Treatment of acromegaly. 02/14/2020. Available at: http://www.uptodate.com/contents/treatment-of-acromegaly [via subscription only]. Accessed April 1, 2020.
Melmed S, Casanueva F, Cavagnini F, et al. Consensus statement: medical management of acromegaly. Eur J Endocrinol. 2005;153(6):737-40.
Melmed S, Colao A, Barkan A, Acromegaly Consensus Group, et al. Guidelines for acromegaly management: an update. J Clin Endocrinol Metab. 2009;94(5):1509-17.
Micromedex Healthcare Series. DrugDex®. Octreotide Acetate. [Micromedex® 2.0 Web site]. updated 03/24/2020. Available at: http://www.micromedexsolutions.com/micromedex2/librarian [via subscription only]. Accessed March 31, 2020.
National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology - Central nervous system cancers. V1.2020. 03/10/20. [NCCN Web site]. Available at: https://www.nccn.org/professionals/physician_gls/pdf/cns.pdf [via free subscription]. Accessed March 31, 2020.
National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology - Neuroendocrine Tumors and Adrenal Tumors. V1.2019. 03/05/19. [NCCN Web site]. Available at: https://www.nccn.org/professionals/physician_gls/pdf/neuroendocrine.pdf [via free subscription]. Accessed March 31, 2020.
National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology - Thymomas and Thymic Carcinomas.V1.2020. 11//27/19. [NCCN Web site]. Available at: https://www.nccn.org/professionals/physician_gls/pdf/thymic.pdf [via free subscription]. Accessed March 31, 2020.
National Comprehensive Cancer Network (NCCN). NCCN Drugs & Biologics Compendium. Octreotide acetate (LAR). [NCCN Web site]. 2020. Available at: https://www.nccn.org/professionals/drug_compendium/content/ [via subscription only]. Accessed March 31, 2020.
Oberg K, Kvols L, Caplin M, et al. Consensus report on the use of somatostatin analogs for the management of neuroendocrine tumors of the gastroenteropancreatic system. Ann Oncol. 2004;15(6):966-73. Review.
Rinke A, Müller HH, Schade-Brittinger C, et al; PROMID Study Group. Placebo-controlled, double-blind, prospective, randomized study on the effect of octreotide LAR in the control of tumor growth in patients with metastatic neuroendocrine midgut tumors: a report from the PROMID Study Group. J Clin Oncol. 2009;27(28):4656-63.
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US Food and Drug Administration (FDA). Center for Drug Evaluation and Research. Octreotide (Sandostatin LAR® Depot) drug label and approval letter [FDA Web site]. updated 04/11/2019. Available at: https://www.accessdata.fda.gov/scripts/cder/daf/. Accessed March 31, 2020.
Policy: 08.01.40b:Lanreotide (Somatuline® Depot)