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Resolution of refractory chemotherapy-induced diarrhea (CID) with octreotide long-acting formulation in cancer patients: 11 case studies

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Abstract

Purpose

Subcutaneous (SC) octreotide has been shown to effectively relieve chemotherapy-induced diarrhea (CID) refractory to conventional therapy but requires t.i.d. injections. A microencapsulated, long-acting formulation (LAR) of octreotide has been developed for once-monthly intramuscular (IM) dosing. Efficacy in resolving severe diarrhea and preventing further episodes of diarrhea in cancer patients was explored.

Patients and methods

Patients with advanced cancer who developed CID and failed conventional antidiarrheal therapy (loperamide + diphenoxylate-atropine) received octreotide LAR IM. The starting dose was either 20 or 30 mg with possible dose escalation from 20 to 30 mg and from 30 to 40 mg. Treatment was repeated every 28 days during chemotherapy.

Results

Complete resolution of diarrhea within 1 to 4 weeks from injection time was seen in all cases with octreotide LAR 30 mg. With a subsequent prophylactic injection once every 28 days, CID was limited to NCI grade 1. This resulted in increased patient quality of life (QOL) and allowed better patient compliance with therapy. Therapy could then be completed at full dose and on schedule after resolution of often debilitating diarrhea.

Conclusion

The ability of octreotide LAR 30 mg to speed the resolution of CID and limit further episodes of diarrhea to infrequent NCI grade 1 controlled with loperamide (prn) suggests that long-acting somatostatin homologues have the potential to be useful in the secondary prevention of diarrhea in patients undergoing chemotherapy.

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References

  1. Arbuckle RB, Huber SL, Zacker C (2000) The consequences of diarrhea occurring during chemotherapy for colorectal cancer: a retrospective study. Oncologist 5:250–259

    CAS  PubMed  Google Scholar 

  2. Barbounis V, Koumakis G, Vassilomanolakis M, Demiri M, Efremidis AP (2001) Control of irinotecan-induced diarrhea by octreotide after loperamide failure. Support Care Cancer 9:258–260

    Article  CAS  PubMed  Google Scholar 

  3. Baskerville A, Batter-Hatton D (1977) Intestinal lesions induced experimentally by methotrexate. Br J Exp Pathol 58:663–669

    CAS  PubMed  Google Scholar 

  4. Cascinu S (1995) Management of diarrhea induced by tumors or cancer therapy. Curr Opin Oncol 7:325–329

    CAS  PubMed  Google Scholar 

  5. Cascinu S, Fedeli A, Fedeli SL et al (1992) Control of chemotherapy-induced diarrhoea with octreotide in patients receiving 5-fluorouracil. Eur J Cancer 28:482–483

    CAS  PubMed  Google Scholar 

  6. Cello JP, Grendell JH, Basuk P, et al (1991) Effect of octreotide on refractory AIDS-associated diarrhea. A prospective, multicenter clinical trial. Ann Intern Med 115:705–710

    CAS  PubMed  Google Scholar 

  7. Conti JA, Kemeny NE, Saltz LB et al (1996) Irinotecan is an active agent in untreated patients with metastatic colorectal cancer. J Clin Oncol 14:709–715

    PubMed  Google Scholar 

  8. Cunningham D, Glimelius B (1999) A phase III study of irinotecan (CPT-11) versus best supportive care in patients with metastatic colorectal cancer who have failed 5-fluorouracil therapy. V301 Study Group. Semin Oncol 26:6–12

    CAS  Google Scholar 

  9. de Roy van Zuidewijn DB, Schillings PH, Wobbes T et al (1992) Histologic evaluation of wound healing in experimental intestinal anastomoses: effects of antineoplastic agents. Int J Exp Pathol 73:465–484

    PubMed  Google Scholar 

  10. Dharmsathaphorn K, Binder HJ, Dobbins JW (1980) Somatostatin stimulates sodium and chloride absorption in the rabbit ileum. Gastroenterology 78:1559–165

    CAS  PubMed  Google Scholar 

  11. Engelking C, Rutledge DN, Ippoliti C et al (1998) Cancer-related diarrhea: a neglected cause of cancer-related symptom distress. Oncol Nurs Forum 25:859–860

    CAS  PubMed  Google Scholar 

  12. Fuessl HS, Carolan G, Williams G et al (1987) Effect of a long-acting somatostatin analogue (SMS 201–995) on postprandial gastric emptying of 99mTc-tin colloid and mouth-to-caecum transit time in man. Digestion 36:101–107

    CAS  PubMed  Google Scholar 

  13. Hogan CM (1998) The nurse’s role in diarrhea management. Oncol Nurs Forum 25:879–886

    CAS  PubMed  Google Scholar 

  14. Kornblau S, Benson AB, Catalano R et al (2000) Management of cancer treatment-related diarrhea. Issues and therapeutic strategies. J Pain Symptom Manage 19:118–129

    Article  CAS  PubMed  Google Scholar 

  15. Kvols LK, Moertel CG, O’Connell MJ et al (1986) Treatment of the malignant carcinoid syndrome. Evaluation of a long-acting somatostatin analogue. N Engl J Med 315:663–666

    CAS  PubMed  Google Scholar 

  16. Moertel CG, Fleming TR, Macdonald JS, et al (1995) Fluorouracil plus levamisole as effective adjuvant therapy after resection of stage III colon carcinoma: a final report. Ann Intern Med 122:321–326

    Google Scholar 

  17. National Cancer Institute (1998) Common toxicity criteria. Bethesda, MD: National Cancer Institute

  18. Petrelli NJ, Rodriguez-Bigas M, Rustum Y et al (1993) Bowel rest, intravenous hydration, and continuous high-dose infusion of octreotide acetate for the treatment of chemotherapy-induced diarrhea in patients with colorectal carcinoma. Cancer 72:1543–1546

    CAS  PubMed  Google Scholar 

  19. Pro B, Lozano R, Ajani JA (2001) Therapeutic response to octreotide in patients with refractory CPT-11 induced diarrhea. Invest New Drugs 19:341–343

    Article  CAS  PubMed  Google Scholar 

  20. Rothenberg ML (2001) Irinotecan (CPT-11): Recent developments and future directions-colorectal cancer and beyond. The Oncologist 6:66–80

    CAS  PubMed  Google Scholar 

  21. Rothenberg ML, Eckardt JR, Kuhn JG et al (1996) Phase II trial of irinotecan in patients with progressive or rapidly recurrent colorectal cancer. J Clin Oncol 14:1128–1135

    CAS  PubMed  Google Scholar 

  22. Rothenberg ML, Meropol NJ, Poplin EA et al (2001) Mortality associated with irinotecan plus bolus fluorouracil/leucovorin: summary findings of an independent panel. J Clin Oncol 19:3801–3807

    CAS  PubMed  Google Scholar 

  23. Rubin J, Ajani J, Schirmer W, et al (1999) Octreotide acetate long-acting formulation vs. open-label subcutaneous octreotide acetate in malignant carcinoid syndrome. J Clin Oncol 17:600–606

    CAS  PubMed  Google Scholar 

  24. Rutledge DN, Engelking C (1998) Cancer-related diarrhea: selected findings of a national survey of oncology nurse experiences. Oncol Nurs Forum 25:861–873

    CAS  PubMed  Google Scholar 

  25. Saltz LB, Cox JV, Blanke C et al (2000) Irinotecan plus fluorouracil and leucovorin for metastatic colorectal cancer. Irinotecan Study Group. N Engl J Med 343:905–914

    Google Scholar 

  26. Takasuna K, Hagiwara T, Hirohashi M et al (1996) Involvement of beta-glucuronidase in intestinal microflora in the intestinal toxicity of the antitumor camptothecin derivative irinotecan hydrochloride (CPT-11) in rats. Cancer Res 56:3752–3757

    PubMed  Google Scholar 

  27. Wadler S, Haynes H, Wiernik PH (1995) Phase I trial of the somatostatin analog octreotide acetate in the treatment of fluoropyrimidine-induced diarrhea. J Clin Oncol 13:222–226

    CAS  PubMed  Google Scholar 

  28. Wadler S, Benson AB 3rd, Engelking C et al (1998) Recommended guidelines for the treatment of chemotherapy-induced diarrhea. J Clin Oncol 16:3169–178

    CAS  PubMed  Google Scholar 

  29. Wakeling AE, Guy SP, Woodburn JR et al (2002) ZD1839 (Iressa): An Orally Active Inhibitor of Epidermal Growth Factor Signaling with Potential for Cancer Therapy. Cancer Res 62:5749–5754

    CAS  PubMed  Google Scholar 

  30. Zidan J, Haim N, Beny A,et al (2001) Octreotide in the treatment of severe chemotherapy-induced diarrhea. Ann Oncol 12:227–229

    Article  CAS  PubMed  Google Scholar 

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  1. Cancer Center of Western Virginia, 2013 South Jefferson Street, Roanoke, VA 24014, USA

    Stephen Rosenoff

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  1. Stephen Rosenoff
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Correspondence to Stephen Rosenoff.

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Rosenoff, S. Resolution of refractory chemotherapy-induced diarrhea (CID) with octreotide long-acting formulation in cancer patients: 11 case studies. Support Care Cancer 12, 561–570 (2004). https://doi.org/10.1007/s00520-003-0507-z

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  • DOI: https://doi.org/10.1007/s00520-003-0507-z

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