An Efficacy and Safety Study of Somatuline Depot (Lanreotide) Injection to Treat Carcinoid Syndrome

Subjects were eligible for participation in the study if they met the following criteria:

   1. At least 18 years of age at the time of first dosing.

   2. Subjects must have given signed informed consent before any study related activities
   were conducted.

   3. Subjects in the United States of America (USA) must have given written authorisation
   for the release of protected health information in compliance with the Health
   Insurance Portability and Accountability Act (HIPAA) regulations; subjects in other
   countries must have provided appropriate authorisation as needed by regulatory
   authorities in each country.

   4. Subjects must have been willing to receive s.c. octreotide injections as rescue
   medication, as needed to control their symptoms, if any.

   5. If female, the subject must not have been pregnant (confirmed by negative pregnancy
   test) and must have had the following documented via verbally given history:

      - At least 1 year postmenopausal (natural cessation of menses), or

      - Surgically sterile (if by tubal ligation, surgery must have been performed more
      than 3 months prior to entry into the study), or

      - If the subject was of childbearing potential and sexually active, she must have
      been using an acceptable form of contraception (oral, injected, transdermal or
      implanted contraceptives, diaphragm or barrier method with spermicidal and/or
      intrauterine device); local methods such as condoms or sponges/vaginal tablets
      were not acceptable forms of contraception.

   6. Subjects with a histopathologically confirmed diagnosis of carcinoid tumour or, a
   carcinoid tumour of unknown location with liver metastases (documented biopsy), and a
   history of carcinoid syndrome (flushing and/or diarrhoea) who were either naïve to
   treatment with a somatostatin analogue (SSTa) or responsive (according to the opinion
   of the principal investigator) to conventional doses of Sandostatin LAR® Depot (LAR;
   ≤30 mg every 4 weeks) or to daily doses of ≤600 μg of s.c. octreotide.

   7. Confirmation of positive somatostatin receptor (SSTR) status by somatostatin receptor
   scintigraphy (SRS; up to 6 months prior to study entry at the Screening Visit).

   8. Absence of tumour progression documented by two sequential computed tomography (CT)
   scans or two sequential magnetic resonance imaging (MRI) scans (≥3 months apart); the
   last CT or MRI scan must have been performed within 6 months of study entry (Screening
   Visit).

   9. Subjects previously treated with LAR, must have received their last dose of LAR at
   least 4 weeks prior to first dose of study treatment (no later than at the Screening
   Visit).

10. Be able to communicate and cooperate with the principal investigator and the staff and
   willing to comply with the study instructions.

Subjects were excluded from entering the study for the following reasons:

   1. History of known allergy or hypersensitivity to investigational drug or any components
   of its formulation, or octreotide.

   2. History of carcinoid syndrome refractory to treatment with conventional doses of SSTa.

   3. Treatment with any other investigational drug within 30 days prior to study entry
   (Screening Visit) and/or at any time during the subject's participation in the study.

   4. Treatment with interferon, chemotherapy and/or radiotherapy (a radiolabelled SSTa)
   and/or tumour debulking <3 months prior to study entry (Screening Visit).

   5. History of hepatic arterial embolisation, hepatic arterial chemoembolisation and/or
   selective internal radiation therapy (selective internal radiation [SIR] therapy
   [SIRT]; e.g. SIR Spheres) <6 months prior to study entry (Screening Visit).

   6. Short bowel syndrome.

   7. Uncontrolled diabetes and/or hypertension.

   8. Severe renal impairment (glomerular filtration rate <30 mL/min/1.73 m2) and/or severe
   liver impairment as evidenced by serum total bilirubin >1.5 mg/dL associated with bile
   duct blockage or with alkaline phosphatase (ALP), aspartate aminotransferase (AST) or
   alanine aminotransferase (ALT) >5.0 upper limit of normal (ULN).

   9. Diagnosis of cardiac disease New York Heart Association (NYHA) functional
   classification >Class I. (Subject has limitation of physical activity. Ordinary
   physical activity causes undue fatigue, palpitation, or dyspnoea).

10. Life expectancy less than 1 year.

11. Any malignancies except carcinoid tumour, basocellular carcinoma of the skin, in situ
   carcinoma of the cervix and ≥5 years disease free after curative cancer treatment.

12. Any serious medical condition that could jeopardise the safety of the subject and/or
   the efficacy assessments of the study.

13. Subject is being treated with a proton pump inhibitor (PPI) and has been at a stable
   dose (no change in dose or frequency of administration) for less than 4 weeks at study
   entry (Screening Visit).