Lenfers B H, Loeffler T M, Droege C M, Hausamen T U
Department of Medicine (Gastroenterology/Medical Oncology/Endocrinology), Staedtische Kliniken Dortmund, Germany.
Ann Oncol. 1999 Oct;10(10):1251-3. doi: 10.1023/a:1008390308416.
Diarrhea is one of the most disturbing effects of chemotherapy, affecting quality of life on the one hand and limiting applicable doses on the other. Irinotecan (CPT-11) and 5-fluorouracil (5-FU) are associated with an elevated risk of developing severe diarrhea. Standard therapy consists of high-dose loperamide, but is associated with frequent failure. Other therapeutic regimens are still experimental. Endoscopic examination of a patient with severe loperamide-resistant diarrhea after CPT-11 chemotherapy revealed an inflammation of the ileo-coecal region. Oral therapy with the topical corticosteroid budesonide was immediately effective. This led to a phase I study of budesonide in CPT-11- and 5-FU-induced and loperamide-refractory diarrhea.
Fourteen patients with CPT-11- and seven patients with 5-FU-induced grade 3-4 (NCI/WHO) diarrhea and loperamide failure were enrolled in this study. All patients had metastatic colorectal cancer.
In 86% of the CPT-11- and 57% of the 5-FU-treated patients with grade 3-4 diarrhea and loperamide failure, treatment with budesonide resulted in a reduction of diarrhea severity by at least two grades.
The orally administered topical active steroid budesonide is highly effective in the therapy of loperamide-refractory chemotherapy (CPT-11 or 5-FU)-induced diarrhea.
腹泻是化疗最令人困扰的副作用之一，一方面影响生活质量，另一方面限制了可应用的剂量。伊立替康（CPT-11）和5-氟尿嘧啶（5-FU）与发生严重腹泻的风险升高有关。标准治疗包括大剂量洛哌丁胺，但常常失败。其他治疗方案仍处于试验阶段。对一名接受CPT-11化疗后出现严重的洛哌丁胺抵抗性腹泻的患者进行内镜检查，发现回盲部有炎症。局部用皮质类固醇布地奈德口服治疗立即起效。这导致了一项关于布地奈德治疗CPT-11和5-FU引起的、洛哌丁胺难治性腹泻的I期研究。
本研究纳入了14例因CPT-11引起腹泻以及7例因5-FU引起3-4级（NCI/WHO）腹泻且洛哌丁胺治疗无效的患者。所有患者均患有转移性结直肠癌。
在因CPT-11引起腹泻的患者中，86%以及在因5-FU引起腹泻的患者中，57%的3-4级腹泻且洛哌丁胺治疗无效的患者，使用布地奈德治疗后腹泻严重程度至少降低了两级。
口服局部活性类固醇布地奈德在治疗洛哌丁胺难治性化疗（CPT-11或5-FU）引起的腹泻方面非常有效。
