Department of Palliative and Supportive Care (M.W., E.H., D.C., A.C.), Rowell Park Comprehensive Cancer Center, Buffalo, NY, USA.
Department of Palliative and Supportive Care (M.W., E.H., D.C., A.C.), Rowell Park Comprehensive Cancer Center, Buffalo, NY, USA.
J Pain Symptom Manage. 2024 Jan;67(1):20-26. doi: 10.1016/j.jpainsymman.2023.09.014. Epub 2023 Sep 27.
Malignant bowel obstruction (MBO) is a common complication of intra-abdominal cancer, frequently seen in advanced gastrointestinal and gynecologic cancer. Management of MBO can be challenging, particularly if the patient is not a surgical candidate. No consensus exists on how best to manage these patients medically. Retrospective studies suggest that the combination of dexamethasone, octreotide and metoclopramide may lead to relief of obstruction and improvement in symptoms associated with the obstruction.
This study seeks to prospectively evaluate the combination of drug "triple therapy" dexamethasone 4 mg BID, metoclopramide 10 mg Q6 and octreotide 300 mcg TID to assess tolerability, safety, and effect on symptoms and deobstruction.
Adults admitted at Roswell Park Comprehensive Cancer Center with malignant bowel obstruction were eligible. Eligible patients who constented to the study were started on the triple therapy with close monitoring of symptoms and for adverse effects.
A total of 15 patients enrolled in the study. Two patients experienced bradycardia as adverse effect and there was no incidence of bowel perforation. All patients who completed the study had complete resolution of their nausea, and improvement in other symptoms including pain, constipation, tolerance of oral intake and resumption of bowel movements. Only two of the 15 patients were alive to complete the six-month post study follow up.
"Triple therapy" with dexamethasone, metoclopramide, and octreotide for management of nonsurgical MBO in this small sample size appears safe and well tolerated however a diagnosis of inoperable MBO remains associated with poor prognosis and death within months.
恶性肠梗阻（MBO）是一种常见的腹腔内癌症并发症，常见于晚期胃肠道和妇科癌症。MBO 的管理具有挑战性，特别是如果患者不是手术候选人。对于如何最好地对这些患者进行药物治疗，尚无共识。回顾性研究表明，地塞米松、奥曲肽和甲氧氯普胺的联合使用可能导致梗阻缓解，并改善与梗阻相关的症状。
本研究旨在前瞻性评估地塞米松 4mg BID、甲氧氯普胺 10mg Q6 和奥曲肽 300mcg TID 三联药物治疗的组合，以评估其耐受性、安全性以及对症状和解除梗阻的影响。
在罗斯韦尔公园综合癌症中心住院的恶性肠梗阻成人患者符合入组条件。同意参加研究的合格患者开始接受三联治疗，并密切监测症状和不良反应。
共有 15 名患者入组本研究。两名患者出现心动过缓的不良反应，没有发生肠穿孔的病例。所有完成研究的患者均完全缓解了恶心，并改善了其他症状，包括疼痛、便秘、口服摄入耐受性和恢复排便。在 15 名患者中，只有 2 名存活并完成了六个月的研究后随访。
在本小样本量中，地塞米松、甲氧氯普胺和奥曲肽三联疗法治疗非手术性 MBO 似乎安全且耐受良好，但不可手术性 MBO 的诊断仍然与预后不良和数月内死亡相关。
