Control of irinotecan-induced diarrhea by octreotide after loperamide failure

Abstract

Diarrhea is a well-recognized side effect of chemotherapy, which affects the quality of life and when refractory is potentially life threatening. Irinotecan (CPT-11) is associated with an elevated incidence of chemotherapy-induced diarrhea and subsequent morbidity. Standard antidiarrheal treatment is based on high-dose loperamide, but this agent is associated with a significant failure rate. Octreotide is active against chemotherapy-induced diarrhea caused by fluoropyrimidines and irinotecan, with a distinct mechanism of action. We administered octreotide in a phase I trial in 37 patients who received irinotecan and experienced loperamide-refractory diarrhea, 23 of whom experienced grade III-IV diarrhea and were treated with loperamide. The 13 patients in whom to loperamide failed to control diarrhea received octreotide, with a high response rate (92%). We conclude that octreotide is effective against loperamide-refractory diarrhea resulting from irinotecan-based chemotherapy.

Advanced Colorectal Cancer: Current Treatment and Nursing Management With Economic Considerations

“…Diarrhea occurs in 50%-80% of patients treated with irinotecan and may be acute or delayed (Barbounis, Koumakis, Vassilomanolakis, Demiri, & Efremidis, 2001). Acute diarrhea occurs within 24 hours of administration and is part of a cholinergic syndrome that also may include rhinitis, hypersalivation, miosis, lacrimation, diaphoresis, fl ushing, and abdominal cramping.…”

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

“…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].…”

Established and potential therapeutic applications of octreotide in palliative care

“…In a phase 1 study of 37 patients receiving irinotecan, grade 3 or 4 diarrhea developed in 23 patients [29]. These 23 patients were treated with loperamide.…”