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How effective octreotide can be (for treatment and symptomatic relief) in the case of bowel obstruction due to cancer cells that attach themselves to the outside of the intestines and prevent them from moving easily to digest food?
In what situations should it be used? Should it be used for symptomatic relief in the case of adhesions caused by surgery?
This is from Wikipedia and seems quite accurate to me:
Octreotide (brand name Sandostatin, Novartis Pharmaceuticals) is an octopeptide that mimics natural somatostatin pharmacologically, though is a more potent inhibitor of growth hormone, glucagon, and insulin than the natural hormone. The Food and Drug Administration (FDA) has approved the usage of a salt form of this peptide, octreotide acetate, as an injectable depot formulation for the treatment of acromegaly, the treatment of diarrhea and flushing episodes associated with carcinoid syndrome, and treatment of diarrhea in patients with vasoactive intestinal peptide-secreting tumors (VIPomas). Octreotide has also been used off-label for the treatment of severe, refractory diarrhea from other causes.
Somatostatin is classified as an inhibitory hormone, whose main actions are to:
Inhibit the release of growth hormone (GH)
Inhibit the release of thyroid-stimulating hormone (TSH)
Suppress the release of gastrointestinal hormones
Vasoactive intestinal peptide (VIP)
Gastric inhibitory polypeptide (GIP)
Lowers the rate of gastric emptying, and reduces smooth muscle contractions and blood flow within the intestine.
Suppress the release of pancreatic hormones
Inhibit the release of insulin
Inhibit the release of glucagon
Suppress the exocrine secretory action of pancreas.
Somatostatin opposes the effects of Growth Hormone-Releasing Hormone (GHRH)
About ten years ago, a series of publications reported on the use of octreotide in the setting of intractable, surgically unresectable, bowel obstruction in people with recurrent cancers.
Ovarian cancer commonly will recur in the abdomen. It is common to experience the obstruction of the stomach, small, and large intestine. Many of these blockages or obstructions in women with ovarian cancer are not surgically resectable. This is because the cancer recurs and causes a coating along the surfaces of other organs. The intestine becomes encased by the cancer coating. The intestine becomes stiff and the diameter of the intestine is narrowed. The normal activity of the bowel which moves the bowel contents forward and through the intestine, called peristalsis, is affected and diminished by the cancer coating.
Octreotide seems to work by reducing gastric and intestinal secretions. This reduces vomiting, abdominal distension , and pain. I have used octreotide alot in my practice. There is along acting form called sandostatin LAR by Novartis. This is a monthly injection and very well tolerated. The injection is painful. Long term use can lead to gallbladder sludge. In general though, there are few side effects.
Octreotide is one of the agents that can improve the quality of life of women with ovarian cancer. Mostly women who received octreotide also have a gastrostomy tube or G-tube. Some of them then also received intravenous food (TPN - total parenteral nutrition)and further chemotherapy. Some of the women on octreotide are not receiving more chemotherapy and are receiving best supportive care.
I am not familiar with the use of octreotide to in the setting of adhesions.
best wishes to you
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