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Recommended Guidelines for the Treatment of Cancer Treatment-Induced Diarrhea

From the Northwestern University Feinberg School of Medicine; University of Chicago Medical Center, Chicago, IL; The University of Texas M.D. Anderson Cancer Center, Houston, TX; Coalition of National Cancer Cooperative Groups, Inc; Thomas Jefferson University, Philadelphia, PA; Arlin Cancer Institute, Westchester Medical Center, Valhalla; Weill Medical College of Cornell University, New York, NY; Mayo Clinic, Rochester, MN; The University of Kansas Medical Center, Kansas City, KS; and University of Iowa Hospitals and Clinics, Iowa City, IA

Address reprint requests to Al B. Benson, III, MD, FACP, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, 676 N St Clair, Suite 850, Chicago, IL 60611; e-mail: a-benson{at}northwestern.edu

PURPOSE: To update and expand on previously published clinical practice guidelines for the treatment of cancer treatment-induced diarrhea.

METHODS: An expert multidisciplinary panel was convened to review the recent literature and discuss recommendations for updating the practice guidelines previously published by this group in the Journal of Clinical Oncology in 1998. MEDLINE searches were performed and the relevant literature published since 1998 was reviewed by all panel members. The treatment recommendations and algorithm were revised by panel consensus.

RESULTS: A recent review of early toxic deaths occurring in two National Cancer Institute-sponsored cooperative group trials of irinotecan plus high-dose fluorouracil and leucovorin for advanced colorectal cancer has led to the recognition of a life-threatening gastrointestinal syndrome and highlighted the need for vigilant monitoring and aggressive therapy for this serious complication. Loperamide remains the standard therapy for uncomplicated cases. However, the revised guidelines reflect the need for recognition of the early warning signs of complicated cases of diarrhea and the need for early and aggressive management, including the addition of antibiotics. Management of radiation-induced diarrhea is similar but may not require hospitalization, and chronic low- to intermediate-grade symptoms can be managed with continued loperamide.

CONCLUSION: With vigilant monitoring and aggressive therapy for cancer treatment-induced diarrhea, particularly in patients with early warning signs of severe complications, morbidity and mortality may be reduced.

The closed roundtable meeting and development of this manuscript were supported by an unrestricted educational grant from Novartis Oncology, a division of Novartis Pharmaceuticals Corporation, East Hanover, NJ. Conflict of interest statements were signed by all participants, and Novartis Oncology was not involved in any of the discussions.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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