Petrelli N J, Rodriguez-Bigas M, Rustum Y, Herrera L, Creaven P
Department of Surgical Oncology, Grace Cancer Drug Center, Roswell Park Cancer Institute, Buffalo, New York 14263.
Cancer. 1993 Sep 1;72(5):1543-6. doi: 10.1002/1097-0142(19930901)72:5<1543::aid-cncr2820720509>3.0.co;2-z.
A prospective trial was conducted involving 16 patients with colorectal adenocarcinoma using a regimen of continuous-infusion octreotide acetate (Sandostatin [octreotide acetate], Sandoz, East Hanover, NJ for the treatment of severe diarrhea induced by the weekly schedule of 5-fluorouracil (5-FU) in combination with leucovorin who were refractory to opiate therapy.
Fifteen patients had tissue-documented metastatic colorectal adenocarcinoma. An additional patient was treated adjuvantly. Fifteen patients were treated with chemotherapy consisting of 5-FU and high-dose leucovorin. The octreotide acetate regimen used was a continuous infusion of 50 micrograms/h for 12 hours followed by 100 micrograms/h for 12 hours and subsequently 150 micrograms/h for 72 hours. All patients were previous failures of diphenoxylate atropine (Lomotil diphenoxalate], Searle, Chicago, IL) given 2.5 mg orally after each loose bowel movement, but no more than 20 mg in a 24-hour period. Opiate therapy was not continued beyond 48 hours. All patients also were treated with bowel rest (nothing by mouth) and intravenous fluid hydration as well as octreotide acetate.
Complete resolution of diarrhea was seen in 15 of 16 patients (94%). In 4 patients this was accomplished during the 100 micrograms/h infusion, and in 11 patients during the 150 micrograms/h infusion. Recurrence of diarrhea was seen in two patients after a complete cycle of octreotide acetate. Both patients were restarted at 150 micrograms/h for 72 hours of octreotide acetate with resolution of the diarrhea within 36 hours of the infusion. No toxicity related to octreotide acetate was seen in this trial.
The continuous-infusion regimen of octreotide acetate 150 micrograms/h is an effective and safe schedule for the treatment of chemotherapy-induced diarrhea together with bowel rest and intravenous fluid hydration in a group of patients in whom the majority were treated with the weekly schedule of 5-FU and high-dose leucovorin.
开展了一项前瞻性试验，纳入16例结肠直肠癌患者，采用持续输注醋酸奥曲肽（善宁[醋酸奥曲肽]，山德士公司，新泽西州东哈嫩）方案，用于治疗因5-氟尿嘧啶（5-FU）联合亚叶酸的每周治疗方案导致的严重腹泻，这些患者对阿片类药物治疗无效。
15例患者经组织学证实为转移性结肠直肠癌。另有1例患者接受辅助治疗。15例患者接受由5-FU和高剂量亚叶酸组成的化疗。所用醋酸奥曲肽方案为：先以50微克/小时持续输注12小时，接着以100微克/小时输注12小时，随后以150微克/小时输注72小时。所有患者此前口服双苯氧酯阿托品（洛哌丁胺，辉瑞公司，伊利诺伊州芝加哥）均无效，每次腹泻后口服2.5毫克，但24小时内不超过20毫克。阿片类药物治疗不超过48小时。所有患者还接受肠道休息（禁食）、静脉补液以及醋酸奥曲肽治疗。
16例患者中有15例（94%）腹泻完全缓解。4例患者在100微克/小时输注期间腹泻缓解，11例患者在150微克/小时输注期间腹泻缓解。2例患者在完成一个醋酸奥曲肽疗程后腹泻复发。这2例患者均重新开始以150微克/小时输注醋酸奥曲肽72小时，输注后36小时内腹泻缓解。本试验未观察到与醋酸奥曲肽相关的毒性反应。
对于大多数接受5-FU每周方案和高剂量亚叶酸治疗的患者，150微克/小时持续输注醋酸奥曲肽方案联合肠道休息和静脉补液是治疗化疗所致腹泻的有效且安全的方案。
