Stufenweise Behandlung bei therapiebedingter Diarrhö

Diarrhea is a common adverse effect of antineoplastic treatment, with incidence rates of up to 20 and 30% in patients on chemotherapy and treatment with immune checkpoint inhibitors (ICI), respectively. An infectious etiology should be ruled out and loperamide started as initial symptomatic treatment. The somatostatin analogue octreotide (s.c.) is recommended as second-line therapy. Conservative symptomatic treatment of diarrhea due to neutropenic enterocolitis consists of bland diet, hydration, effective pain management, and antibiotic therapy with piperacillin/tazobactam or a carbapenem. Patients with mild ICI-induced diarrhea should be treated symptomatically, with corticosteroids initiated for CTCAE grade 2 diarrhea. Monoclonal antibodies directed against tumor necrosis factor such as infliximab or adalimumab or the monoclonal anti-integrin antibody vedolizumab should be used in cases of severe and/or steroid-refractory diarrhea.