Management of cancer treatment-related diarrhea. Issues and therapeutic strategies.
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.
Kornblau
S
S
University of Texas M.D. Anderson Cancer Center, Houston, TX 77030-4095, USA.
Benson
A B
AB
Catalano
R
R
Champlin
R E
RE
Engelking
C
C
Field
M
M
Ippoliti
C
C
Lazarus
H M
HM
Mitchell
E
E
Rubin
J
J
Stiff
P J
PJ
Vokes
E
E
Wadler
S
S
D000970:Antineoplastic Agents / Q000009:adverse effects*; D003967:Diarrhea / Q000139:chemically induced* / Q000188:drug therapy / Q000209:etiology*; D006086:Graft vs Host Disease / Q000150:complications*; D006801:Humans; D009369:Neoplasms / Q000628:therapy; D017410:Practice Guidelines as Topic
D000970:Antineoplastic Agents