Background: The Common Toxicity Criteria of the National Cancer Institute evaluates diarrhea as an adverse event of chemotherapy administration. Acute graft versus host disease (aGVHD) causes diarrhea in allogeneic hematopoietic stem cell transplant patients. Guidelines for treating grade 3 and 4 chemotherapy induced diarrhea (CID) include octreotide acetate, a somatostatin analogue. These recommendations are based on adult octreotide trials. Data on octreotide use for treatment of CID in pediatric oncology patients are limited. This study evaluated the efficacy and safety of octreotide in the treatment of CID or aGVHD induced diarrhea in pediatric patients.
Methods: This is a retrospective review of 34 patients of average age 6 years who received octreotide between 1994 and 2008 for treatment of CID or aGVHD induced diarrhea.
Results: Thirty-eight courses of intravenous octreotide were administered. A complete response was achieved during 25/27 (92%) CID and 5/11 (45%) aGVHD induced diarrhea courses. A partial response was achieved during 4/38 courses, all in the aGVHD induced diarrhea group. No response was observed for 3 of the aGVHD induced diarrhea courses and 1 for the CID course. Octreotide was initiated at 2 mcg/kg/day and increased to a maximum of 9 mcg/kg/day. The mean total duration of treatment was 9 days. Common adverse effects observed were hyperglycemia, hyberbilirubinemia, nausea/vomiting, and abdominal cramping.
Conclusion: In pediatric patients, octreotide exhibits 92% efficacy in treating CID and 45% efficacy in aGVHD induced diarrhea. Further studies to better characterize the starting dose and dose escalation algorithm for treating CID in children are required.