Guidelines for Complications of Cancer Treatment Vol VIII Part B

Treatment of gastrointestinal mucositis1. The panel recommends either ranitidine or omeprazolefor the prevention of epigastric pain after treatment withcyclophosphamide, methotrexate, and 5-FU or aftertreatment with 5-FU with or without folinic acidchemotherapy (level of evidence, II; grade ofrecommendation, A).2. Chemotherapy-induced diarrhea is a common clinicalproblem associated with certain drugs used to treat coloncancer and other solid tumors (5-FU, irinotecan) andwith high-dose chemotherapy coupled with HSCT.Irinotecan-induced diarrhea occurs in 2 phases: an acutesyndrome (within the first 24 hours), which is mediatedby acetylcholine and blocked by atropine, followed bya delayed phase, which is inflammatory. Octreotide, asomatostatin analogue, regulates intestinal water andelectrolyte transport, inhibits gut hormones. Whenloperamide fails to control diarrhea induced by standarddoseor high-dose chemotherapy associated with HSCT,the panel recommends octreotide at a dose of at least100 mg administered subcutaneously twice daily (levelof evidence, II: grade of recommendation, A).Future Directions and Areas of Research1. The prevalence of mucositis is largely remainsunreported therefore there is a need for studies reportingthe exact prevalence using standard nomenclature, costof therapy, prevention and treatment.2. More research is required to assess the risk assessmentbased on genetics3. Development of other agents which are cost effective460