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Chemo Diarrhea

Posted Aug 24 2008 1:49pm
ANNOUNCER: Diarrhea is a common side effect of chemotherapy. Quick treatment is important, for patients can become seriously dehydrated. But there's another life-threatening danger. Severe diarrhea can make a patient's quality of life so poor that he or she ends up taking less-than-optimal doses of chemotherapy drugs or ends the therapy early.

STEPHEN ROSENOFF, MD: The adjuvant therapy for colon cancer, given after surgery, offers the patients the opportunity of approximately a one-third improvement in the five-year survival and probably a cure.

Chemotherapy-induced diarrhea that's not treated properly results in between 15-20% of the patients stopping this therapy that has the potential to increase the cure rate.

ANNOUNCER: Doctors have a number of treatments available to help curb diarrhea. These include over-the-counter medications that slow down the movement of the bowels, to increase the absorption of fluids. There are also hormonal agents that work on several fronts to counteract cellular damage caused by cancer treatment.

STEPHEN ROSENOFF, MD: In chemotherapy-induced diarrhea, there's not only injury to the lining surface of the gut, which is what happens in the most common diarrheas, the infectious diarrheas, for which Imodium and Lomotil can be used, and with reasonable effectiveness.

In chemotherapy-induced diarrhea, there is an increase in the immature goblet cells. These are cells that are specifically designed to produce secretions and mucus. And so the diarrhea that occurs in chemotherapy is a secretory diarrhea and an exudative diarrhea, where there's an outpouring of things into the gut as well.

ANNOUNCER: Researchers discovered a hormone in the body called somatostatin helps regulate secretions by the goblet cells. Scientists have formulated drugs that act like somatostatin, called somatostatin analogues.

STEPHEN ROSENOFF, MD: They are synthetic drugs mirroring the hormone somatostatin. Somatostatin lasts only one to three minutes in the body. So we wouldn't want to use that. A new drug called octreotide or Sandostatin, has a half-life much longer, 30-90 minutes.

ANNOUNCER: Several studies have shown Sandostatin, was effective in curbing serious cases of chemotherapy-induced diarrhea.

STEPHEN ROSENOFF, MD: And in these trials, whereas the conventional Lomotil and Imodium work 15-20% of the time in Grade 3 and 4 diarrhea, the Sandostatin was effective within two to three days in stopping the diarrhea in between 85-95% of the patients. A dramatic difference.

ANNOUNCER: That result came with a form of Sandostatin that's given by injection several times a day.

Doctors are also investigating a long-acting version of the drug, which is given just once a month.

STEPHEN ROSENOFF, MD: My study examines the first 10 patients that I treated with the long-acting Sandostatin, the Sandostatin LAR.

In all of these patients, they had resolution of the diarrhea, improvement of their quality of life, prompt resolution of the cramping pain that is really so miserable for the patients. All of this is very, very important. And this allowed them to complete their therapy without decreasing the dose.

ANNOUNCER: Right now, most doctors use Sandostatin against diarrhea only after other therapies have failed. New studies may show hormonal agents can effective at onset of diarrhea. Or even earlier to prevent diarrhea in the first place. Any decrease in cases of diarrhea among cancer patients would be welcome, for psychological as well as physiological reasons.

STEPHEN ROSENOFF, MD: When they get severe chemotherapy-induced diarrhea, this will often knock the props out from underneath them. This will tell them: This is a horrible treatment, this is a horrible disease, and I might die from this. So it's very depressing.

In the patients thereafter that have treated with the long-acting somatostatin, the Sandostatin LAR, they have reported to me that they would never have finished their treatment without it. It's allowed them to go out with their family. It's allowed them to go to dinner.

ANNOUNCER: Larger, well-controlled studies are necessary before researchers really understand the full value of hormonal therapy in treating chemotherapy-induced diarrhea.

But if early evidence holds up, doctors say hormonal agents could improve the quality of life for many patients on chemotherapy. And that, in turn could save lives, because it would help many of those patients stick with difficult anti-cancer treatment.

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