Recommended guidelines for the treatment of cancer treatment-induced diarrhea.
OBJECTIVE
To update and expand on previously published clinical practice guidelines for the treatment of cancer treatment-induced diarrhea.


METHODS
An expert multidisciplinary panel was convened to review the recent literature and discuss recommendations for updating the practice guidelines previously published by this group in the Journal of Clinical Oncology in 1998. MEDLINE searches were performed and the relevant literature published since 1998 was reviewed by all panel members. The treatment recommendations and algorithm were revised by panel consensus.


RESULTS
A recent review of early toxic deaths occurring in two National Cancer Institute-sponsored cooperative group trials of irinotecan plus high-dose fluorouracil and leucovorin for advanced colorectal cancer has led to the recognition of a life-threatening gastrointestinal syndrome and highlighted the need for vigilant monitoring and aggressive therapy for this serious complication. Loperamide remains the standard therapy for uncomplicated cases. However, the revised guidelines reflect the need for recognition of the early warning signs of complicated cases of diarrhea and the need for early and aggressive management, including the addition of antibiotics. Management of radiation-induced diarrhea is similar but may not require hospitalization, and chronic low- to intermediate-grade symptoms can be managed with continued loperamide.


CONCLUSIONS
With vigilant monitoring and aggressive therapy for cancer treatment-induced diarrhea, particularly in patients with early warning signs of severe complications, morbidity and mortality may be reduced.
Benson
Al B
AB
Robert H. Lurie Comprehensive Cancer Center of Northwestern University, 676 N St Clair, Suite 850, Chicago, IL 60611, USA. a-benson@northwestern.edu
Ajani
Jaffer A
JA
Catalano
Robert B
RB
Engelking
Constance
C
Kornblau
Steven M
SM
Martenson
James A
JA
McCallum
Richard
R
Mitchell
Edith P
EP
O'Dorisio
Thomas M
TM
Vokes
Everett E
EE
Wadler
Scott
S
D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000930:Antidiarrheals / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects*; D003967:Diarrhea / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D006801:Humans; D009369:Neoplasms / Q000628:therapy; D011878:Radiotherapy / Q000009:adverse effects*
D000900:Anti-Bacterial Agents; D000930:Antidiarrheals; D000970:Antineoplastic Agents