Management of Cancer Treatment–Related Diarrhea

Abstract

The cancer treatment-related diarrhea caused by acute graft-versus-host disease (GVHD) and chemotherapeutic agents, particularly fluoropyrimidines and irinotecan, significantly affects patient morbidity and mortality. The mechanisms causing cancer treatment-related diarrhea are not fully understood, but histopathologic evidence points to a multifactorial process that causes an absorptive and secretory imbalance in the small bowel. Cancer treatment-related diarrhea could be life-threatening, yet assessment and treatment are not currently standardized. Several clinicians participated in a closed roundtable meeting to review the mechanisms of chemotherapy-induced diarrhea (CID) and GVHD-induced diarrhea, management issues in cancer treatment-induced diarrhea, and pharmacologic approaches to treatment. The meeting produced a proposal for new treatment guidelines and an algorithm, which include the use of octreotide for the management of CID- and GVHD-induced diarrhea. The development of diarrhea assessment guidelines that expand on the current National Cancer Institute criteria and allow for better patient management was also proposed.

St. John’s Wort Modulates the Toxicities and Pharmacokinetics of CPT-11 (Irinotecan) in Rats

“…As the major active metabolite of CPT-11, SN-38 may bind to intestinal epithelial Topo I and induce cellular apoptosis (32,33). CPT-11 and SN-38 also induced the secretion of Na + and Cl j (34) and stimulated the production of proinflammatory cytokines and prostaglandins (35,36). Early treatment of severe late-onset diarrhea with high-dose loperamide (a synthetic opiate derivative) resulted in a decreased diarrhea and patient morbidity (37).…”

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

“…Octreotide has been shown to control 5-FU-induced diarrhea [5,28] as well as diarrhea induced by a number of other conditions including AIDS [6,12], carcinoid syndrome [15], and vasoactive intestinal polypeptide tumors [10]. The use of octreotide to control severe diarrhea can be cost-effective in preventing the need for hospitalization and additional patient care [14].…”

“…This agent acts directly on epithelial cells to reduce secretion of a number of pancreatic and gastrointestinal hormones including serotonin, vasoactive intestinal polypeptide (VIP), gastrin, insulin, glucagon, growth hormone, secretin, motilin, and pancreatic polypeptides [27]. Octreotide has been shown to be effective in the control of 5-FU-and CPT-11-induced diarrhea [2,3,18,19,28,30] and is recommended for the treatment of severe diarrhea (grades 3-4) refractory to opioids treatment [14,27].…”

“…The principal adverse events associated with CPT-11 therapy are neutropenia (over 30% grade 3 or 4) and delayed diarrhea (over 80% all grades and 5 to 30% of grade 3 or 4) [14]. The pathophysiologic mechanism responsible for the severity of CPT-11-induced CID differs from that of 5-FU-induced diarrhea.…”

Side effect management during treatment of gastrointestinal (GI) cancers

“…Dependant on risk classifi cation according to the recent published guideline loperamide is recommended in standard and intensifi ed dosage (Tab. 2) [12,17,19]. Th e synthetic analogue of somatostatin, octreotide, has been Tab.…”