Oral Ondansetron Offers Effective Antidiarrheal Activity for Carcinoid Syndrome Refractory to Somatostatin Analogs

The Oncologist
Barbara KiesewetterMarkus Raderer

Abstract

Somatostatin analogs (SSAs) are standard for symptomatic patients with neuroendocrine tumors (NETs). However, most patients experience tachyphylaxis, and limited options exist for this so-called "refractory carcinoid syndrome." Recently, 5-HT3 antagonist ondansetron has been associated with reduction of bowel movement in a small series. The aim of this analysis was to assess effectiveness of ondansetron for symptomatic treatment of carcinoid syndrome. We have analyzed patients given ondansetron as bridging therapy for refractory carcinoid syndrome. The dose was 2 × 8 mg for 5 days, followed by reduction to 1 × 8 mg in case of benefit. A total of 14 patients with small bowel NETs metastatic to the liver were identified. All patients had been treated with SSAs for a median time of 18 months before aggravation of diarrhea. One patient had to be excluded because of an underlying infectious cause of diarrhea. The median number of daily bowel movements was 7 (range, 5-13) before initiation of therapy. At this time, seven patients had stable disease, whereas six patients showed radiological progression with symptomatic breakthrough. All 13 patients were scheduled for salvage therapy. Remarkably, in 85% (11/13) ondansetron resulted in ...Continue Reading

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Citations

Aug 20, 2019·Pancreas·Boris G NaraevThorvardur R Halfdanarson
Sep 27, 2019·Endocrine Reviews·Johannes HoflandWouter W de Herder
Apr 24, 2020·Journal of Oncology·Dominique ClementRaj Srirajaskanthan
Aug 21, 2020·ESMO Open·Barbara Kiesewetter, Markus Raderer
Sep 3, 2020·World Journal of Gastroenterology : WJG·Mohid S KhanEnrique Grande
Mar 20, 2019·World Journal of Gastroenterology : WJG·Dominique Svm ClementJohn K Ramage

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