Patients with nonresectable metastatic neuroendocrine tumors (
NETs) experience symptoms of hormone hypersecretion including diarrhea, flushing, and bronchoconstriction, which can interfere with quality of life [Anthony and Vinik (2011) Pancreas, 40:987]. Treatment with a long‐acting release formulation of octreotide, a somatostatin analog, can help to alleviate these symptoms. Although high doses of octreotide are often required for adequate symptom control, the relationship between octreotide dose escalation and symptom control in the NETcontext is not well quantified in the literature. A retrospective chart review was conducted of nonresectable metastatic NETpatients who received a dose greater than 30 mg intramuscular octreotide long‐acting formulation (O‐ LAR) at any time between January 2005 and December 2011 at the British Columbia Cancer Agency ( BCCA). The association between dose escalation of O‐ LAR, chromogranin A ( CGA), 24‐h urine 5‐hydoxyindoacetate (5‐ HIAA), symptom control, and radiological progression was explored. Dose escalation of O‐ LARwas associated with improved symptom control in NETpatients who were refractory to the standard dose levels. Reduction of serum CGA & 5‐HIAA levels by at least 10% was observed in 31% and 23% respectively. Retrospective review of imaging did not document any reductions in tumor volume. Higher doses of O‐ LARare associated with improved symptom control in NETpatients. The variability in tumor marker levels in response to O‐ LARdose escalation may indicate that tumor marker levels may not be an accurate assessment of therapeutic efficacy.