Double-blind, placebo-controlled, randomized trial of octreotide in malignant bowel obstruction

David Currow, Stephen Quinn, Meera Agar, Belinda Fazekas, Janet Hardy, Nicola McCaffrey, Simon Eckermann, Amy Abernethy, Katherine Clark

    Research output: Contribution to journalArticle

    47 Citations (Scopus)

    Abstract

    Context Does octreotide reduce vomiting in cancer-associated bowel obstruction? Objectives To evaluate the net effect of adding octreotide or placebo to standardized therapies on the number of days free of vomiting for populations presenting with vomiting and inoperable bowel obstruction secondary to cancer or its treatment. Methods Twelve services enrolled people with advanced cancer presenting with vomiting secondary to bowel obstruction where surgery or anti-cancer therapies were not indicated immediately. In a double-blind study, participants were randomized to placebo or octreotide (600 μg/24 hours by infusion). Both arms received standardized supportive therapy (infusion of ranitidine [200 mg/24 hours], dexamethasone [8 mg/24 hours], and parenteral hydration [10-20 mL/kg/24 hours]). The primary outcome was patient-reported days free of vomiting at 72 hours. Results In a study that recruited to the numbers identified in its power calculation, 87 participants provided data at 72 hours (45, octreotide arm). Seventeen people (octreotide) and 14 (placebo) were free of vomiting for 72 hours (P = 0.67). Mean days free of vomiting were 1.87 (SD 1.10; octreotide) and 1.69 (SD 1.15; placebo; P = 0.47). An adjusted multivariate regression of the incidence of vomiting over the study showed a reduced number of episodes of vomiting in the octreotide group (incidence rate ratio = 0.40; 95% CI: 0.19-0.86; P = 0.019); however, people in the octreotide arm were 2.02 times more likely to be administered hyoscine butylbromide (P = 0.004), potentially reflecting increased colicky pain. Conclusion Although there was no reduction in the number of days free of vomiting, the multivariate analysis suggests that further study of somatostatin analogues in this setting is warranted.

    Original languageEnglish
    Pages (from-to)814-821
    Number of pages8
    JournalJournal of Pain and Symptom Management
    Volume49
    Issue number5
    DOIs
    Publication statusPublished - 1 May 2015

    Keywords

    • Malignant bowel obstruction
    • net clinical benefit
    • octreotide
    • palliative care
    • randomized controlled trial
    • vomiting

    Fingerprint Dive into the research topics of 'Double-blind, placebo-controlled, randomized trial of octreotide in malignant bowel obstruction'. Together they form a unique fingerprint.

    Cite this