Sun, J.X., & Yang, N. (2013). Role of octreotide in post chemotherapy and/or radiotherapy diarrhea: Prophylaxis or therapy? Asia-Pacific Journal of Clinical Oncology. Advance online publication.  doi:10.1111/ajco.12055

Databases searched were MEDLINE, EMBASE, Cochrane Collaboration, and BIOSIS.

Search keywords were octreotide, somatostatin, and diarrhea.

Studies were included in the review if they were randomized clinical trials (RCTs) with with one group receiving octreotide.

Exclusion criteria was not specified.

• A total of 37 references were retrieved.
• Quality grading was done using the Jadad scale.  Odds ratio analysis was used.

• Eight studies were included in the final review, representing 572 patients. The sample range across studies was 16–315.
• Five studies involved chemotherapy, and three studies involved radiotherapy.

All patients were undergoing the active treatment phase of care.

• Octreotide was effective compared to placebo (overall response [OR] = 4.9, 95% confidence interval [CI], 1.58–15.2).
• With radiotherapy-induced diarrhea, octreotide OR = 1.64 (95% CI, 0.53–5.08) and the test for overall effect was not significant. 
• For chemotherapy-induced diarrhea, OR =14.7 (95% CI,  4.06–53.26) and the test for overall effect was significant (p < 0.0001).
• The radiotherapy data showed high heterogeneity.
• The OR of octreotide was higher when used for treatment rather than prophylactically. However, only one trial evaluated prophylactic use.
• Most studies compared octreotide to loperamide.

Prophylactic use of octreotide did not show a statistically significant reduction in diarrhea. Octreotide did not reduce severity or incidence of diarrhea during pelvic radiotherapy, and some bowel functions appeared to be worse in the octreotide group. Octreotide showed significant benefit for the treatment of chemotherapy-induced diarrhea.

A limited number of studies were evaluated. No firm conclusions regarding prophylactic use can be made.

Findings support the use of octreotide for management of chemotherapy-induced diarrhea. Prophylactic use and use in patients with diarrhea because of pelvic irradiation are not supported. Nurses can advocate for appropriate use of octreotide in the management of diarrhea.