Long-acting octreotide for the treatment of symptoms of bowel obstruction and intermittent obstruction in advanced ovarian cancer

Abstract

5148 Background: Bowel obstruction and symptoms of chronic bowel obstruction are common complications reported in up to 40% of patients (pts) with recurrent ovarian cancer. Reasons for bowel obstruction include carcinomatosis with multiple points of obstruction, drug-induced intestinal immobility, and less commonly intraluminal obstruction. Octreotide inhibits gastrointestinal hormonal secretion and decreases splanchnic blood flow. Sandostatin LAR (LAR) is a long-acting depot form of octreotide given IM monthly. Methods: The objectives of this trial are to assess efficacy and toxicities of LAR in ovarian cancer pts with chronic or intermittent bowel obstruction. Eligible pts must have recurrent ovarian or primary peritoneal cancer, symptoms related to a non-surgically amenable bowel obstruction, and have a life expectancy of >2 months. Following a test dose of short-acting octreotide to rule out skin toxicity, SQ octreotide was started at a dose of 100 mcg 3x/day x 2 weeks (in order to quickly achieve therapeutic serum levels) simultaneously with LAR 30 mg IM qmonth. IM LAR was given until symptom progression or toxicity. EORTC QOL surveys were followed qmonth. Results: Since the study's initiation in 9/02, 10 pts have been enrolled. The mean age of pts is 56 yrs of age. Because one enrolled pt never received any study drug, data is available for 9 pts. Of the 10 pts enrolled, 8 have died from their cancer. One pt received a successful test dose and one LAR injection, but was removed from study per her request. Of the patients who received >2 months of therapy (6 pts), the duration of therapy ranged from 2 to 9 months with a median of 3.5 months duration of LAR. There were no grade 3/4 toxicities related to LAR, and LAR was overall well tolerated. 2 pts had skin reactions, one which necessitated removal of the pt from trial. Conclusions: LAR octreotide is well tolerated following successful administration of a test dose of SQ octreotide. In this ovarian cancer population with inoperable bowel obstruction, LAR octreotide has activity in the management of symptoms of bowel obstruction. No significant financial relationships to disclose.