Bhattacharya, S., Vijayasekar, C., Worlding, J., & Mathew, G. (2009). Octreotide in chemotherapy induced diarrhoea in colorectal cancer: A review article. Acta Gastro-Enterologica Belgica, 72(3), 289–295.

To assess the role of octreotide in the management of chemotherapy-induced diarrhea (CID) in patients with colorectal cancer

Databases searched were Pubmed, MEDLINE, and Cochrane Database (1984–2009).

Search keywords were ocreotide in chemotherapy-induced diarrhea, octerotide CID, colorectal cancer CID, and octreotide.

Studies were included in the review if they

• Were published in the English language.
• Reported on a sample that was all or primarily patients with colorectal cancer.

Studies were excluded if they

• Involved the use of chemotherapy used solely for the treatment of cancers other than colorectal cancer.
• Were solitary case reports.

The authors did not describe the literature review and evaluation process. The article did incorporate information on relevant clinical guidelines.

The authors reviewed two randomized trials; four nonrandomized, controlled studies; and two case series, involving a total of 169 patients.

• The two randomized trials demonstrated that octreotide was superior to loperamide in controlling severe CID.
• In one of the nonrandomized trials, patients with loperamide-resistant CID had complete (16%) or substantial (59%) resolution of CID.
• In another nonrandomized trial, which included patients with other types of cancer, 94% achieved complete resolution of diarrhea with octreotide.
• A prospective trial and two case series reported similar successful treatment of severe CID (grade 3 and above) with octreotide.
• The Canadian Working Group on CID has recommended that patients with refractory CID at grade 3 or 4 receive 100–150 mg octreotide subcutaneously three times daily, with potential increased doses up to 500 mg three times per day.
• For prophylaxis treatment, the group has recommended 30 mg octreotide long-acting release intramuscularly once every 28 days.
• Adverse effects included short-term local pain at the injection site (38%), fatigue (48%), weakness (33%), and nausea (28%). Long-term use in acromegaly has been associated with vitamin B₁₂ deficiency and risk of gallstone formation.
• A review of economic issues identified a study that found that the mean expenditure for CID in Canada was $2,559 per patient for grade 3 or 4 diarrhea. The average expenditure with grade 4 was $5,776. The cost of octreotide was not reported.

Octreotide has been shown to be effective and safe for short-term treatment of severe CID.

Few studies have been done with the long-acting formulation and for prophylactic use. Further studies in these areas would be useful.

Nurses should be aware of potential side effects with long-term use as seen in other than cancer cases.