PP-21 Optimizing end-of-life care and quality of life for patients with unresectable insulinomas: a comprehensive analysis of the last advancements on medical treatments

<h3>Introduction</h3> Unresectable insulinomas, while rare, present significant challenges in end-of-life care due to persistent hypoglycemia and associated morbidity. These tumors are often malignant and metastatic, affecting elderly and frail patients who may not be candidates for surgical intervention. Effective management of symptoms and stabilization of the disease are critical in enhancing the quality of life in this patient population. <h3>Aims</h3> This study aims to evaluate the effectiveness of various treatment modalities for unresectable insulinomas, with a focus on symptom management, and enhancing end-of-life care. <h3>Methods</h3> A comprehensive search of the PubMed, Scopus, and Web of Science databases was conducted to identify relevant studies following the PRISMA 2020 guidelines. <h3>Results</h3> 19 individuals with malignant tumors from 10 studies have been included, with a mean age of over 70 years. Tumor sizes ranged from 13 mm to 300 mm, with most tumors located in the pancreas and liver metastases present in several cases. The medical treatments for insulinomas showed varying effectiveness in controlling hypoglycemia. Octreotide and its long-acting analogs, especially octreotide LAR, were highly effective in stabilizing blood glucose levels with fewer injections. Everolimus was crucial for cases where other treatments failed, also helping manage metastatic disease. Diazoxide worked for some but was often limited by side effects like fluid retention. Lutetium-177 octreotate provided long-term control in refractory cases, with patients experiencing extended periods of euglycemia. Adverse effects were generally manageable, although diazoxide was associated with significant side effects in some cases. <h3>Conclusion</h3> This study underscores the importance of a multi-disciplinary approach in the end-of-life care of patients with unresectable insulinomas. <h3>Impact</h3> This analysis provides insights into optimizing end-of-life care for patients with unresectable insulinomas, highlighting the role of advanced pharmacological interventions and targeted radiotherapy. The findings support a patient-centered approach, focusing on symptom management and quality of life, essential for enhancing end-of-life care in this challenging clinical scenario.’