Recommended guidelines for the treatment of chemotherapy-induced diarrhea.

Wadler, Scott; Benson, Al B.; Engelking, Constance; Catalano, Robert B.; Field, Michael J.; Kornblau, Steven M.; Mitchell, Edith; Rubin, Joseph; Trotta, Paul P.; Vokes, Everett E.

doi:10.1200/jco.1998.16.9.3169

Cited by 146 publications

(108 citation statements)

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“…Guidelines for evaluation and management of patients with CID are presented in Figure 2 [Wadler et al 1998, Benson et al 2004. The tempo and specific nature of treatment is guided by the classification of the symptom constellation as complicated or uncomplicated.…”

Section: Summary Of the Consensus Recommendationsmentioning

confidence: 99%

Review: Chemotherapy-induced diarrhea: pathophysiology, frequency and guideline-based management

2009

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Diarrhea is one of the main drawbacks for cancer patients. Possible etiologies could be radiotherapy, chemotherapeutic agents, decreased physical performance, graft versus host disease and infections. Chemotherapy-induced diarrhea (CID) is a common problem, especially in patients with advanced cancer. The incidence of CID has been reported to be as high as 5080% of treated patients (30% CTC grade 35), especially with 5-fluorouracil bolus or some combination therapies of irinotecan and fluoropyrimidines (IFL, XELIRI). Regardless of the molecular targeted approach of tyrosine kinase inhibitors and antibodies, diarrhea is a common side effect in up to 60% of patients with up to 10% having severe diarrhea. Furthermore, the underlying pathophysiology is still under investigation. Despite the number of clinical trials evaluating therapeutic or prophylactic measures in CID, there are just three drugs recommended in current guidelines: loperamide, deodorized tincture of opium and octreotide. Newer strategies and more effective agents are being developed to reduce the morbidity and mortality associated with CID. Recent research focusing on the prophylactic use of antibiotics, budesonide, probiotics or activated charcoal still have to define the role of these drugs in the routine clinical setting. Whereas therapeutic management and clinical work-up of patients presenting with diarrhea after chemotherapy are rather well defined, prediction and prevention of CID is an evolving field. Current research focuses on establishing predictive factors for CID like uridine diphosphate glucuronosyltransferase-1A1 polymorphisms for irinotecan or dihydropyrimidine-dehydrogenase insufficiency for fluoropyrimidines.

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Section: Summary Of the Consensus Recommendationsmentioning

confidence: 99%

Review: Chemotherapy-induced diarrhea: pathophysiology, frequency and guideline-based management

2009

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“…19 Octreotide was recommended for the control of chemotherapy-induced diarrhea in guidelines from the American Society of Clinical Oncology 20 and by a second group that published updated recommendations in 2004. 21 Yavuz and colleagues 22 reported the results of a randomized clinical trial that assessed the effectiveness of octreotide in patients with diarrhea caused by pelvic radiation therapy.…”

Section: Journal Of Clinical Oncology O R I G I N a L R E P O R Tmentioning

confidence: 99%

Phase III, Double-Blind Study of Depot Octreotide Versus Placebo in the Prevention of Acute Diarrhea in Patients Receiving Pelvic Radiation Therapy: Results of North Central Cancer Treatment Group N00CA

Martenson

Halyard

Sloan

et al. 2008

JCO

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A B S T R A C T PurposeTo assess the effectiveness of depot octreotide for the prevention of diarrhea during pelvic radiation therapy. Patients and MethodsPatients receiving pelvic radiation therapy (planned minimum dose, 45 Gy; 1.7 to 2.1 Gy daily) were eligible for the study. From May 10, 2002, through October 14, 2005 patients were randomly allocated in a double-blind fashion to receive octreotide (100 g, administered subcutaneously on day 1, followed by depot octreotide, 20 mg, administered intramuscularly on days 2 and 29; n ϭ 62) or to receive a placebo (n ϭ 63). ResultsGrade 0, 1, 2, and 3 diarrhea were observed in 18%, 31%, 31%, and 21% of patients in the octreotide arm, respectively, and in 25%, 32%, 22%, and 21% of patients in the placebo arm, respectively (P ϭ .64). Grade 0, 1, 2, and 3 abdominal cramps were observed in 32%, 45%, 21%, and 2% of patients receiving octreotide, respectively, and in 51%, 24%, 21%, and 5% of patients receiving the placebo, respectively (P ϭ .053). Some patient-reported symptoms were worse in the octreotide group, including nocturnal bowel movements (70% v 45%; P ϭ .004), clustering of bowel movements (90% v 69%; P ϭ .004), and bleeding with bowel movements (57% v 35%; P ϭ .01). ConclusionAs administered in this study, octreotide did not decrease diarrhea during pelvic radiation therapy. Some gastrointestinal symptoms were worse in patients treated with octreotide. Octreotide is not indicated for prevention of diarrhea during pelvic radiation therapy.

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“…Moreover, no standard methods of diagnosis or therapeutic protocols exist for chemotherapy-induced enteritis, and further research into new therapeutic avenues for treatment or prevention of this intestinal injury is needed. 24) The present study examined the relationship between plasma GLP-2 levels and changes in proliferative markers resulting from MTX-induced intestinal mucositis.…”

mentioning

confidence: 99%

Correlation between Plasma Glucagon-Like Peptide 2 Levels and Proliferative Makers in Small Intestinal Injury in Rats Induced by Methotrexate Administration

Hirotani

Yamamoto

Ikeda

et al. 2006

Biological & Pharmaceutical Bulletin

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Chemotherapy is an important primary and adjuvant therapy for cancer patients. The cytotoxicity of antineoplastic agents affects not only tumor cells but also rapidly proliferating normal cells, such as those of the gastrointestinal mucosa.1) Common complications of chemotherapy thus include stomatitis and enterocolitis.2) Methotrexate (MTX) is an antimetabolite drug that blocks the production of biologically active forms of folic acid. The major lesions resulting from its cytotoxic effects occur in bone marrow and the intestinal tract. High doses of MTX cause severe enterocolitis, weight loss, anorexia and intestinal atrophy. 3,4) The mucosa of the digestive tract, particularly that of the small intestine, is a critical site of action of anticancer agents including MTX, as the undifferentiated epithelial cells in the crypts, which ensure continuous and relatively fast regeneration of the epithelium, are particularly sensitive to these cytostatic drugs.5-7) Patients receiving these anticancer agents frequently experience gastrointestinal side effects, such as nausea, vomiting and diarrhea, reflecting gastrointestinal mucosal damage or enterocolitis.2) Chemotherapy-associated diarrhea may be problematic, and even life threatening, if complicated by mucosal ulceration and inflammatory changes. Moreover, patients with advanced malignancy often suffer from malnutrition, which increases toxicity and decreases tumor responses to treatment,2) and such conditions can be dose limiting in therapeutic regimens. A method for prediction of adverse reactions to chemotherapy is thus needed to avoid their occurrence.Gastrointestinal mucosal integrity is regulated by several growth factors and cytokines, such as transforming growth factors-beta and IL-11.8-11) Glucagon-like peptide 2 (GLP-2) has been demonstrated to have intestinotrophic effects. 12)GLP-2, a 33-amino acid peptide member of a family of proglucagon-derived peptides (PGDP) that also includes enteroglucagon, is secreted from L-type entero-endocrine cells of the distal small intestine and colon.12) GLP-2 increases crypt cell proliferation and decreases the rate of apoptosis in small intestinal epithelium.13) Acute or chronic administration of GLP-2 induces functional changes in the intestine, improving its capacity for nutrient absorption. [13][14][15] In addition, GLP-2 treatment has been shown to enhance intestinal adaptation following major small bowel resection, 16,17) to prevent 18) and to reduce the severity of dextran sulfate-induced colitis 19) and indomethacin-induced enteritis 20) in animal models. On the other hand, plasma GLP-2 levels appear to vary with intestinal mucosal condition and injury. However, although changes in various conditions of the intestinal mucosa are now being widely studied, [21][22][23] the relationship between plasma GLP-2 levels and intestinal mucosal injury induced by various drugs, including antineoplastic agents, has yet to be clearly determined. Moreover, no standard methods of diagnosis or therapeutic protocols exist for chemo...

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Recommended guidelines for the treatment of chemotherapy-induced diarrhea.

Cited by 146 publications

References 0 publications

Review: Chemotherapy-induced diarrhea: pathophysiology, frequency and guideline-based management

Review: Chemotherapy-induced diarrhea: pathophysiology, frequency and guideline-based management

Phase III, Double-Blind Study of Depot Octreotide Versus Placebo in the Prevention of Acute Diarrhea in Patients Receiving Pelvic Radiation Therapy: Results of North Central Cancer Treatment Group N00CA

Correlation between Plasma Glucagon-Like Peptide 2 Levels and Proliferative Makers in Small Intestinal Injury in Rats Induced by Methotrexate Administration

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