Prevention and Management of Chemotherapy-Induced Diarrhea in Patients with Colorectal Cancer: A Consensus Statement by the Canadian Working Group on Chemotherapy-Induced Diarrhea

Abstract

Chemotherapy-induced diarrhea (cid) is a common side effect of cancer treatment and can cause significant morbidity and mortality. Diarrhea is frequently severe enough to require a dose reduction of, a delay in, or a discontinuation of chemotherapy. Diarrhea-associated mortality has been reported to be as high as 3.5% in clinical trials of irinotecan and bolus 5-fluorouracil in colorectal cancer. The frequency of cid and its impact on patient management are frequently under-recognized in clinical practice.A Canadian working group, consisting of medical oncologists and an oncology pharmacist, was formed in 2001 to review the optimal approach to managing cid and to identify and implement new areas of research. The recommendations that follow are the result of the group’s work.Acute medical management of cid includes loperamide or diphenoxylate as first-line agents. Subcutaneous octreotide is recommended for intractable grade 2 diarrhea and may be considered for grade 1 cid that does not resolve with high-dose loperamide. Hospitalization is recommended for patients with grades 3 and 4 cid; in-hospital care includes rehydration, antibiotic therapy, and octreotide.A chemotherapy dose reduction is generally advised for patients who have experienced grade 3 or 4 diarrhea in a previous chemotherapy cycle. If a dose reduction is not desired, prophylaxis with intramuscular long-acting release octreotide may be considered.The foregoing recommendations are based on expert opinion and require validation in prospective clinical trials.

Chemotherapy-Induced Constipation and Diarrhea: Pathophysiology, Current and Emerging Treatments

“…Diarrhea is a frequently under-recognized clinical issue that significantly affects morbidity and mortality of cancer patients worldwide (Maroun et al, 2007). Prevalence and severity of CID vary greatly depending on chemotherapeutic regime administration and dosage.…”

“…A direct correlation between cumulative dose and severity of CID has been recognized, with high dose regimens associated with heightened incidence of CID (Verstappen et al, 2003). Certain regimens, especially those containing 5-fluorouracil and irinotecan are associated with rates of CID of up to 80% (Benson et al, 2004a; Richardson and Dobish, 2007) with one third of patients experiencing severe (grade 3 or 4) diarrhea ( Table 2 ) (Maroun et al, 2007). …”

“…Similarly, a combination of Lactobacillus rhamnosus and fiber has been found to reduce the severity of grade 3/4 5-fluorouracil/leucovorin-induced diarrhea by 15% in a randomized study of patients treated for colorectal cancer (Österlund et al, 2007). Administration of oral antibiotics, such as fluoroquinolone, has also been recommended for aggressive treatment of CID (Benson et al, 2004a; Maroun et al, 2007). …”

Systemic Therapies in Metastatic Non-Small-Cell Lung Cancer with Emphasis on Targeted Therapies: The Rational Approach

“…General management may include bowel rest, hydration, and replacement of electrolytes. Hospitalization is required for patients with dehydration, fever, neutropenia, or nausea and vomiting that prevents adequate oral hydration93.…”

Antitumor Effects and Immunomodulating Activities ofPhellinus linteusExtract in a CT-26 Cell-Injected Colon Cancer Mouse Model

“…Treatments range from folk remedies to the use of sophisticated drugs. Despite these options, colon cancer remains difficult to treat; the great majority of chemical compounds that are cytotoxic to cancer cells are also toxic to normal cells (Maroun et al, 2007). The discovery and identification of drugs that have potent antitumor activity and minimal side effects have become important goals of research in the biomedical sciences (Takeda et al, 1969).…”