A systematic review of irinotecan-induced diarrhea during a protracted administration schedule for sarcoma patients-therapeutic mechanism and clinical management
MA Heng-yue
XU Jie
SUN Xin
XIE Lu
TANG Xiao-dong
Abstract：Irinotecan-induced diarrhea, especially delayed diarrhea, is the most common and dose-limiting side effect of irinotecan. Evidence has shown that antitumor activity of irinotecan is enhanced with protracted schedule with longer duration and lower daily dose administration in sarcoma compared to a single higher dose in colorectal cancer. Poor compliance to prescriptions in children and young adults, overlapping of the acute and delayed symptoms, prolonged administration period and deteriorated general health status. In this review, we discuss the mechanisms and their possible clinical applications in the prophylaxis and management of irinotecan-induced diarrhea in protracted schedule for pediatric patients with sarcoma, and propose comprehensive strategy for the management of diarrhea in these patients. No robust biomarker has been found in relation to diarrhea. Prophylactic use of cephalosporins and early salvage treatment with intensive loperamide are required. Further positive therapy including octreotide and/or racecadotril, fluid resuscitation, symptomatic and supportive therapy are essential in the management of diarrhea.
Keywords：IrinotecanDiarrheaSoft tissue sarcomaChemoradiotherapyadjuvantClinical protocols
Publication Date：2025-05-19
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：9( 461-469 )