Octreotide for chemotherapy induced diarrhea – pro

Chemotherapy-induced diarrhea is a common complication of chemotherapy. The first steps are stopping the chemo, hydration and anti-diarrheal agents. Several small trials have reported good results using subcutaneously administered, short-acting octreotide acetate in patients who have failed initial therapy with loperamide. Although several recent studies appear to show that octreotide is not effective in prophylaxis, it continues to be recommended in review articles and guidelines. While the optimal dose of octreotide has not been determined, a panel of experts has recommended that complicated cases of diarrhea should be managed with IV fluids, octreotide at a starting dose of 100 to 150 μg subcutaneously (SC) 3 times a day or 25 to 50 μg/hour IV with a dose escalation to 500 μg 3 times a day, and administration of antibiotics. This regimen should be continued until the patient has been diarrhea free for 24 hours.
Based on these, admittedly older guidelines, octreotide is still “supported”. NCCN om PLA-19 aso recommends it for grade 3-4 diarrhea.

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

Barbounis V, Koumakis G, Vassilomanolakis M, et al: Control of irinotecan-induced diarrhea by octreotide after loperamide failure. Support Care Cancer 9:258-260, 2001.

James A. Martenson, Michele Y. Halyard, Jeff A. Sloan, Gary M. Proulx, Robert C. Miller, Richard L. Deming, Stephen J. Dick, Harold A. Johnson, T.H. Patricia Tai, Angela W. Zhu, Joan Keit, Kathy J. Stien, Pamela J. Atherton 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 JCO November 10, 2008 vol. 26 no. 32 5248-5253

A. Stein, Review: Chemotherapy-induced diarrhea: pathophysiology, frequency and guideline-based management
Therapeutic Advances in Medical Oncology Jan 1, 2010:51-63

B. Zachariah et al, Octreotide Acetate in Prevention of Chemoradiation-Induced Diarrhea in Anorectal Cancer: Randomized RTOG Trial 0315
JNCI J Natl Cancer Inst Apr 21, 2010:547-556

Benson AB 3rd, Ajani JA, Catalano RB, et al.: Recommended guidelines for the treatment of cancer treatment-induced diarrhea. J Clin Oncol 22 (14): 2918-26, 2004.

NCCN, Palliative Care PAL-19, 2018

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