SAGE Journals Online
Advertisement
Sign In to gain access to subscriptions and/or personal tools.

 

Advanced Search

Journal Navigation

Journal Home

Subscriptions

Archive

Contact Us

Table of Contents

Advertisement

Sign In to gain access to subscriptions and/or personal tools.
Journal of Oncology Pharmacy Practice
This Article
Right arrow Abstract Freely available
Right arrow Free Full Text (Free PDF) Free
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Saved Citations
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Request Reprints
Right arrow Add to My Marked Citations
Citing Articles
Right arrow Citing Articles via Google Scholar
Right arrow Citing Articles via Scopus
Google Scholar
Right arrow Articles by Richardson, G.
Right arrow Articles by Dobish, R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Richardson, G.
Right arrow Articles by Dobish, R.
Social Bookmarking
Add to CiteULike   Add to Complore   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

Chemotherapy induced diarrhea

Gillian Richardson

Cross Cancer Institute, Edmonton, Alberta, Canada

Roxanne Dobish, BscPharm

Provincial Pharmacy, Cross Cancer Institute, Edmonton, Alberta, Canada, roxanned{at}cancerboard.ab.ca

Purpose: To provide a current review of the literature related to chemotherapy induced diarrhea (CID), including clinical assessment, recommended management guidelines and investigational pharmacological approaches for the prevention and treatment of CID.

Data sources: A search of MEDLINE, PubMed, EMBASE, Cochrane Library, International Pharmaceutical Abstracts, and Web of Science (1996—2006) databases was conducted using terms such as: chemotherapy, diarrhea, diarrhoea, and irinotecan. Appropriate references from selected articles were also used. The search engine, Google, provided further access to information.

Data extraction: The retrieved literature was reviewed to include all articles pertaining to the pathophysiology, assessment and management of CID.

Data synthesis: Diarrhea is a debilitating and potentially life-threatening side effect associated with many chemotherapeutic agents. Despite the high incidence and severity of CID, it is often under recognized and poorly managed. A multidisciplinary panel recently updated recommended practice guidelines for the assessment and management of CID. Prompt and aggressive intervention is important in order to minimize the negative consequences of CID, such as dehydration, which may cause interruptions in optimal clinical outcomes or may lead to life-threatening sequelae. Further investigation into the pathophysiology of CID may allow for more directed approaches in the prophylaxis and treatment of CID. J Oncol Pharm Practice (2007) 13: 181—198.

Key Words: chemotherapy • irinotecan • diarrhea • guidelines • loperamide • octreotide

References

  • Arnold RJG, Gabrail N., Raut M., Kim R., Sung JCY, Zhou Y. Clinical implications of chemotherapy-induced diarrhea. J Support Oncol 2005; 3: 227—32.[Medline] [Order article via Infotrieve]
  • Sharma R., Tobin P., Clarke SJ Management of chemotherapy-induced nausea vomiting, oral mucositis and diarrhea. Lancet Oncol 2005; 6: 93—102.[CrossRef][Medline] [Order article via Infotrieve]
  • Arbuckle RB, Huber SL, Zacker C. The consequences of diarrhea occurring during chemotherapy for colorectal cancer: a retrospective study. Oncologist 2000; 5: 250—59.[Abstract/Free Full Text]
  • Kornblau S., Benson AB, III, Catalano R. et al. Management of cancer treatment-related diarrhea: Issues and therapeutic strategies. J Pain Symptom Manage 2000; 19: 118—29.[CrossRef][Medline] [Order article via Infotrieve]
  • Gastrointestinal Complications — Diarrhea. National Cancer Institute. Available at: http://www.cancer.gov/cancertopics/pdq/supportivecare/gastrointestinalcomplications/healthprofessional/page5. Accessed May 19, 2006.
  • Rosenoff S. Resolution of refractory chemotherapy induced diarrhea (CID) with octreotide long-acting formulation in cancer patients: 11 case studies. Support Care Cancer 2004; 12: 561—70.[Medline] [Order article via Infotrieve]
  • Saltz LB Understanding and managing chemotherapy-induced diarrhea. J Support Oncol 2003; 1: 35—46.[Medline] [Order article via Infotrieve]
  • Cancer Therapy Evaluation Program. Common Toxicity Criteria, Version 2.0. National Cancer Institute, Bethesda; National Institutes of Health, U.S. Department of Health and Human Services. April 30, 1999.
  • Cancer Therapy Evaluation Program. Common Terminology Criteria for Adverse Effects, Version 3.0. National Cancer Institute, Bethesda; National Institutes of Health, U.S. Department of Health and Human Services. December 12, 2003.
  • Walder S. Treatment guidelines for chemotherapy-induced diarrhea. Oncology Special Edition (McMahon Med) 2005; 8: 105—10.
  • Mercadante S. Diarrhea in terminally ill patients: Pathophysiology and treatment. J Pain Symptom Manage 1995; 10: 298—309.[CrossRef][Medline] [Order article via Infotrieve]
  • Field M. Intestinal ion transport and the pathophysiology of diarrhea. J Clin Invest 2003; 111: 931—43.[CrossRef][Medline] [Order article via Infotrieve]
  • Forrester A. Diarrhea. In Repchinsky C, Leblanc C, Jovaisas B, Leahey K, Way C. eds. Patient Self Care. Ottawa, Ontario, Canadian Pharmacists Association, 2002: 238—50.
  • Diskin A. Gastroenteritis. eMedicine (from WebMD). February 28, 2006. Available at: http://www.emedicine.com/EMERG/topic213.htm. Accessed May 18, 2006.
  • Yang X., Hu Z., Chan SY et al. Novel agents that potentially inhibit irinotecan-induced diarrhea. Curr Med Chem 2005; 12: 1343—58.[CrossRef][Medline] [Order article via Infotrieve]
  • Xu Y., Villalona-Calero MA Irinotecan: mechanisms of tumor resistance and novel strategies for modulating its activity. Ann Oncol 2002; 13: 1841—51.[Abstract/Free Full Text]
  • Innocenti F., Iyer L., Ratain MJ Pharmacogenetics of anticancer agents: lessons from amonafide and irinotecan. Drug Metab Dispos 2001; 29: 596—600.[Abstract/Free Full Text]
  • Ikegami T., Ha L., Arimori K. et al. Intestinal alkalization as a possible preventative mechanism in irinotecan (CPT-11)-induced diarrhea. Cancer Res 2002; 62: 179—87.[Abstract/Free Full Text]
  • Alimonti A., Gelibter A., Pavese I. et al. New approaches to prevent intestinal toxicity of irinotecan-based regimens. Cancer Treat Rev 2004; 30: 555—62.[CrossRef][Medline] [Order article via Infotrieve]
  • Bengt G. Benefit-risk assessment of irinotecan in advanced colorectal cancer. Drug Saf 2005; 28: 417—33.[CrossRef][Medline] [Order article via Infotrieve]
  • Crews KR Individualizing chemotherapeutic treatment of colorectal cancer. Am J Health-Syst Pharm 2006; 63: S12—S17.[Abstract/Free Full Text]
  • Borner MM, Bernhard J., Dietrich D. et al. A randomized phase II trial of capecitabine and two different schedules of irinotecan in first-line treatment of metastatic colorectal cancer: efficacy, quality of life and toxicity. Ann Oncol 2005; 16: 282—88.[Abstract/Free Full Text]
  • Barbounis V., Koumakis G., Vassilomanolakis M., Demiri M., Efremidis AP Control of irinotecan-induced diarrhea by octreotide after loperamide failure. Support Care Cancer 2001; 9: 258—60.[CrossRef][Medline] [Order article via Infotrieve]
  • Earle CC, Kwok A., Gazelle GS, Fuchs CS Two schedules of second-line irinotecan for metastatic colon carcinoma. Cancer 2004; 101: 2533—39.[Medline] [Order article via Infotrieve]
  • Rothenberg ML Efficacy and toxicity of irinotecan in patients with colorectal cancer. Semin Oncol 1998; 25: 39—46.[Medline] [Order article via Infotrieve]
  • Shah A. BCCA Guidelines on chemotherapy-induced diarrhea. October 13, 2004. In de Lemos ML, ed. BC Cancer Agency Cancer Drug Manual. Vancouver, British Columbia: BC Cancer Agency. Available at: http://www.bccancer.bc.ca/NR/rdonlyres/4E7EF86A-EAA5-4F3C-B147B2512799F6B3/7371/GuidelinesforManagementofCID.pdf. Accessed May 25, 2006.
  • Michael M., Brittain M., Nagai J. et al. Phase II study of activated charcoal to prevent irinotecan induced diarrhea. J Clin Oncol 2004; 22: 4410—17.[Abstract/Free Full Text]
  • Diarrhea and Constipation (Chapter 27). The Merck Manual of Diagnosis and Therapy. Available at: http://www.merck.com/mrkshared/mmanual/section3/chapter27/27b.jsp. Accessed July 10, 2006.
  • Viele CS Overview of chemotherapy induced diarrhea. Semin Oncol Nurs 2003; 19: 2—5.[Medline] [Order article via Infotrieve]
  • Saliba F., Hagipantelli R., Misset JL et al. Pathophysiology and therapy of irinotecan-induced delayed-onset diarrhea in patients with advanced colorectal cancer: a prospective assessment. JClin Oncol 1998; 16: 2745—51.
  • Govindarajan R., Heaton KM, Broadwater R., Zeitlin A., Lang NP, Hauer-Jensen M. Effect of thalidomide on gastrointestinal toxic effects of irinotecan. Lancet 2000; 356: 566—67.[CrossRef][Medline] [Order article via Infotrieve]
  • Dodds HM, Rivory LP The mechanism for the inhibition of acetylcholinesterases by irinotecan (CPT-11). Mol Pharmacol 1999; 56: 1346—53.[Abstract/Free Full Text]
  • Trifan OC, Durham WF, Salazar VS et al. Cyclooxygenase2 inhibition with celecoxib enhances antitumor efficacy and reduces diarrhea side effect of CPT-11. Cancer Res 2002; 62: 5778—84.[Abstract/Free Full Text]
  • Rougier P., Bugat R., Douillard JY et al. Phase II study of irinotecan in the treatment of advanced colorectal cancer in chemotherapy-naive patients and patients pretreated with fluorouracil-based chemotherapy. JClin Oncol 1997; 15: 251—60.
  • Camptosar (Product monograph). Pfizer Canada Inc. April 13, 2006. Available at: http://www.pfizer.ca/english/our%20products/prescription%20pharmaceuticals/default.asp?s=1. Accessed June 13, 2006.
  • Irinotecan (Drug monograph). May 2006. In de Lemos ML, ed. BC Cancer Agency Cancer Drug Manual. Vancouver, British Columbia: BC Cancer Agency. Available at: http://www.bccancer.bc.ca/NR/rdonlyres/777153D1-62E3-49B7-838A-06A031117E60/15966/Irinotecanmonograph_1May06_rev1.pdf. Accessed May 30, 2006.
  • Yumuk PF, Aydin SZ, Dane F. et al. The absence of early diarrhea with atropine premedication during irinotecan therapy in metastatic colorectal patients. Int J Colorectal Dis 2004; 19: 609—10.[CrossRef][Medline] [Order article via Infotrieve]
  • Von Hoff DD, Rothenberg ML, Pitot HC, et al. Irinotecan (CPT-11) therapy for patients with previously treated metastatic colorectal cancer (CRC): Overall results of FDA-reviewed pivotal US clinical trials. Proc Am Soc Clin Oncol 1997; 16: 228a (abstract 803).
  • Brandi G., Dabard J., Raibaud P. et al. Intestinal microflora and digestive toxicity of irinotecan in mice. Clin Cancer Res 2006; 12: 1299—1307.[Abstract/Free Full Text]
  • Chowbay B., Sharma A., Zhou Q., Cheung YB, Lee EJD. The modulation of irinotecan-induced diarrheao and pharmacokinetics by three different classes of pharmacological agents. Oncol Rep 2003; 10: 745—51.[Medline] [Order article via Infotrieve]
  • Furman WL, Crews KR, Billups C. et al. Cefixime allows greater dose escalation of oral irinotecan: a phase 1 study in pediatric patients with refractory solid tumors. J Clin Oncol 2006; 24: 563—70.[Abstract/Free Full Text]
  • Mori K., Kondo T., Kamiyama Y., Kano Y., Tominaga K. Preventative effect of Kampo medicine (Haneshashin-to) against irinotecan-induced diarrhea in advanced non-small cell lung cancer. Cancer Chemother Pharmacol 2003; 51: 403—6.[Medline] [Order article via Infotrieve]
  • Pan C., Loehrer P., Seitz D. et al. A phase II trial of irinotecan, 5-fluorouracil and leucovorin combined with celecoxib and glutamine as first line therapy for advanced colorectal cancer. Oncology 2005; 69: 63—70.[CrossRef][Medline] [Order article via Infotrieve]
  • Benson AB, III, Ajani JA, Catalano RB et al. Recommended guidelines for the treatment of cancer-treatment induced diarrhea. J Clin Oncol 2004; 22: 2918—26.[Abstract/Free Full Text]
  • Rothenberg ML, Meropol NJ, Poplin EA, Van Cutsem E., Wadler S. Mortality associated with irinotecan plus bolus fluorouracil/leucovorin: Summary findings of an independent panel. J Clin Oncol 2001; 19: 3801—07.[Abstract/Free Full Text]
  • von Bultzingslowen I., Adlerberth I., Wold AE, Dahlen G., Jontell M. Oral and intestinal microflora in 5-fluorouracil treated rats, translocation to cervical and mesenteric lymphnodes and effects of probiotic bacteria. Oral Microbiol Immunol 2003; 18: 278—84.[CrossRef][Medline] [Order article via Infotrieve]
  • Jansman FGA, Sleijfer DT, de Graaf JC, CoenenJllm, BrouwersJRBJ., Management of chemotherapy-induced adverse effects in the treatment of colorectal cancer. Drug Saf 2001; 24: 353—67.[CrossRef][Medline] [Order article via Infotrieve]
  • Irinotecan (Drug monograph). Cancer Care Ontario. Available at: http://www.cancercare.on/pdfdrugs/irinot.pdf. Accessed May 30, 2006.
  • BCCA protocol summary for palliative therapy of advanced colorectal cancer using leucovorin and fluorouracil. British Columbia Cancer Center. Available at: http://www.bccancer.bc.ca/NR/rdonlyres/C0A8933B3AAD-4EBA-A95C-4552A0A060C9/14326/GIFUFA_1mar2006.pdf. Accessed June 30, 2006.
  • Diarrhea. American Cancer Society. Available at: http://www.cancer.org/docroot/MBC/content/MBC_2_3X_Diarrhea.asp?sitearea=MBC. Accessed July 11, 2006.
  • e-CPS. Canadian Pharmacists Association. Available at: http://www.pharmacists.ca/function/Subscriptions/ecps.cfm. Accessed July 4, 2006.
  • Major P., Figueredo A., Tandan V. et al. Role of octreotide in the management of patients with cancer. Curr Oncol 2003; 10: 161—79.
  • Rosenoff SH Octreotide LAR resolves severe chemotherapy-induced diarrhea (CID) and allows continuation of full-dose therapy. Eur J Cancer Care 2004; 13: 380—83.[CrossRef]
  • Karthaus M., Ballo H., Abenhardt W. et al. Prospective, double blind, placebo controlled, multicenter, randomized phase III study with orally administered budesonide for prevention of irinotecan (CPT-11)-induced diarrhea in patients with advanced colorectal cancer. Oncology 2005; 68: 326—32.[CrossRef][Medline] [Order article via Infotrieve]
  • Deodorized tincture of opium. American Cancer Society. Available at: http://www.cancer.org/docroot/CDG/content/CDG_deodorized_tincture_of_opium.asp Accessed December 28, 2006.
  • Ulbricht C, Basch E, eds. Psyllium. Natural Standard [database online]. Link from the University of Alberta Library. Available at: http://www.naturalstandard.com.login.ezproxy.library.ualberta.cal. Accessed March 13, 2007.
  • Ulbricht C, Basch E, eds. Lactobacillus acidophilus. Natural Standard [database online]. Link from the University of Alberta Library. Available at: http://www.naturalstandard.com.login.ezproxy.library.ualberta.ca/ Accessed December 27, 2006.
  • Wang HH, Shieh MJ, Liao KF A blind, randomized comparison of racecadotril and loperamide for stopping acute diarrhea in adults. World J Gastroenterol 2005; 11: 1540—43.[Medline] [Order article via Infotrieve]
  • Lecomte JM An overview of clinical studies with racecadotril in adults. Int JAntimicrob Agents 2000; 14: 81—87.[CrossRef]
  • Prado D. A multinational comparison of racecadotril and loperamide in the treatment of acute watery diarrhoea in adults. Scand J Gastroenterol 2002; 37: 656—61.[CrossRef][Medline] [Order article via Infotrieve]
  • Daniele B., Perrone F., Gallo C. et al. Oral glutamine in the prevention of fluorouracil induced intestinal toxicity: a double bind, placebo controlled randomized trial. Gut 2001; 48: 28—33.[Abstract/Free Full Text]
  • Study of Glutamine as Prophylaxis for Irinotecan Induced Diarrhea. Clinical trial sponsored by the Alberta Cancer Board. Available at: http://www.clinicaltrials.gov/ct/show/NCT00255229;jsessionid=25C18C79C872C1A7D9C827A4861C8D1D?order=43. Accessed June 30, 2006.
  • Reardon DA, Qiunn JA, Vredenburgh J. et al. Phase II Trial of Irinotecan plus Celecoxib in Adults with Recurrent Malignant Glioma. Cancer 2005; 103: 329—38.[CrossRef][Medline] [Order article via Infotrieve]
  • Kehrer DFS, Sparreboom A., Verweij J. et al. Modualtion of Irinotecan-induced diarrhea by cotreatment with neomycin in cancer patients. Clin Cancer Res 2001; 7: 1136—41.[Abstract/Free Full Text]
  • Takeda Y., Tsuduki E., Izumi S. et al. A phase I/II trial of irinotecan-cisplatin combined with anti-late-diarrhoeal programme to evaluate the safety and antitumour response of this combination therapy in patients with advanced non-small-call lung cancer. Br J Cancer 2005; 93: 1341—49.[CrossRef][Medline] [Order article via Infotrieve]
  • Personal communication. Health Canada Special Access Program (December 21, 2006).
  • Shinohara H., Killion JJ, Bucana CD, Yano CD, Fidler IJ Oral administration of the immunomodulator JBT-3002 induces endogenous interleukin 15 in intestinal macrophages for protection against irinotecan-mediated destruction of intestinal epithelium. Clin Cancer Res 1999; 5: 2148—56.[Abstract/Free Full Text]
  • Shinohara H., Bucana CD, Killion JJ, Fidler IJ Intensified regression of colon cancer liver metastases in mice treated with irinotecan and the immunomodulator JBT 3002. J Immunother 2000; 23: 321—31.[Medline] [Order article via Infotrieve]
  • Kuhn JG Influence of anticonvulsants on the metabolism and elimination of irinotecan. A North American Brain Tumor Consortium preliminary report. Oncology (Huntingt) 2002; 16: 33—40.
  • Crews KR, Stewart CF, Jones-Wallace D. et al. Altered irinotecan pharmacokinetics in pediatric high-grade glioma patients receiving enzyme-inducing anticonvulsant therapy. Clin Cancer Res 2002; 8: 2202—09.[Abstract/Free Full Text]
  • Manatsathit S., Dupont HL, Farthing M., Kositchaiwat C. et al. Guideline for the management of acute diarrhea in adults. J Gastroenterol Hepatol 2002; 17: S54—S71.[CrossRef][Medline] [Order article via Infotrieve]
  • Lee J. Pseudomembranous Colitis. eMedicine (from WebMD). July 1, 2005. Available at: http://www.emedicine.com/med/topic1942.htm. Accessed May 29, 2006.
  • Dranitsaris G., Maroun J., Shah A. Severe chemotherapy induced diarrhea in patients with colorectal cancer: A cost of illness analysis. Support Care Cancer 2005; 13: 318—24.[CrossRef][Medline] [Order article via Infotrieve]
  • Wong AS, Lam CS, Tambyah PA Fatal chemotherapy associated Clostridium difficile infection — a case report. Singapore Med J 2001; 42: 214—16.[Medline] [Order article via Infotrieve]
  • Morales Chamorro R., Serrano Blanch R., Mendez Vidal MJ et al. Pseudomembranous colitis associated with chemotherapy with 5-fluorouracil [in Spanish; English Abstract]. Clin Transl Oncol 2005; 7: 258—61.[CrossRef][Medline] [Order article via Infotrieve]
  • Blot E., Escande MC, Besson D. et al. Outbreak of Clostridium difficile-related diarrhea in an adult oncology unit: risk factors and microbiological characteristics. J Hosp Infect 2003; 53: 187—92.[CrossRef][Medline] [Order article via Infotrieve]
  • Kamthan AG, Bruckner HW, Hirschman SZ, Agus SG Clostridium-difficile diarrhea induced by cancer-chemotherapy. Arch Intern Med 1992; 152: 1715—17.[Abstract/Free Full Text]
  • Yokoyama T., Kondo H., Yokota T. et al. Colonoscopy for frank bloody stools associated with cancer chemotherapy. Jpn J Clin Oncol 1997; 27: 111—14.[Abstract/Free Full Text]

Journal of Oncology Pharmacy Practice, Vol. 13, No. 4, 181-198 (2007)
DOI: 10.1177/1078155207077335
Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?



This Article
Right arrow Abstract Freely available
Right arrow Free Full Text (Free PDF) Free
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Saved Citations
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Request Reprints
Right arrow Add to My Marked Citations
Citing Articles
Right arrow Citing Articles via Google Scholar
Right arrow Citing Articles via Scopus
Google Scholar
Right arrow Articles by Richardson, G.
Right arrow Articles by Dobish, R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Richardson, G.
Right arrow Articles by Dobish, R.
Social Bookmarking
Add to CiteULike   Add to Complore   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

Advertisement