J Pain Symptom Manage. 2014 Nov 14. doi: 10.1016/j.jpainsymman.2014.09.013. [Epub ahead of print]

Double-Blind, Placebo-Controlled, Randomized Trial of Octreotide in Malignant Bowel Obstruction

Currow DC, Quinn S, Agar M, Fazekas B, Hardy J, McCaffrey N, Eckermann S, Abernethy AP, Clark K

In a double-blind multicentre RCT in Australia, people with advanced cancer presenting with vomiting secondary to inoperable bowel obstruction, where anti-cancer therapies were not immediately appropriate, were randomised to placebo or octreotide (600mcg/d) infusion. Both arms received ranitidine, dexamethasone, parenteral hydration and symptomatic therapies. The primary outcome was the number of patient-reported days free of vomiting at three days. At three days, 87 participants provided data (45 in the octreotide arm); of these 17 (octreotide) and 14 (placebo) were free of vomiting for three days. The mean number days free of vomiting were 1.9 (octreotide) and 1.7 (placebo). There was no statistical difference between these groups for the primary outcome. For the secondary outcomes, both groups had a decrease in the mean number of episodes of vomiting between baseline and day 1; the incidence of vomiting over the study period showed a reduced number of episodes of vomiting with octreotide, but this group were twice as likely to be administered hyoscine butylbromide, potentially reflecting increased colicky pain. Octreotide was well tolerated and there was no difference in toxicity between groups. Overall, there was also no difference in nausea, pain or survival between groups. This study does not support the routine use of octreotide in addition to standard care for the reduction of vomiting in inoperable malignant bowel obstruction, however in view that the secondary endpoint of episodes of vomiting was reduced with octreotide, the authors recommend further study of octreotide in this setting.

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