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Medical management of malignant bowel obstruction in patients with advanced cancer: 2021 MASCC guideline update

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Abstract

Background

Malignant bowel obstruction (MBO) is a frequent complication in patients with advanced cancer, particularly colon or gynecological malignancies. MASCC previously published a guideline for symptom management of MBO in 2017. This is a 5-year update.

Method

A systematic search and review of relevant literature includes a review published in 2010 and 2017. The guideline update used the same literature search process as followed in 2015. The dates of the new search included 2015 up to February 2, 2021. The guidelines involved the pharmacologic management of nausea and vomiting in malignant bowel obstruction (MBO) only. Only randomized trials were included in the updated guideline as evidence. The evidence was reviewed by the panel and the MASCC criteria for establishing a guideline were followed using MASCC level of grading and category of evidence.

Results

There was one systematic review and 3 randomized trials accepted as evidence from 257 abstracts. Octreotide is effective in reducing gastrointestinal secretions and colic and thereby reduces nausea and vomiting caused by MBO. Scopolamine butylbromide is inferior to octreotide in the doses used in the comparison study. Olanzapine or metoclopramide may be effective in reducing nausea and vomiting secondary to partial bowel obstructions. The panel suggests using either drug. Additional studies are needed to clarify benefits. Haloperidol has been used by convention as an antiemetic but has not been subjected to a randomized comparison. Ranitidine plus dexamethasone may be effective in reducing nausea and vomiting from MBO but cannot be recommended until there is a comparison with octreotide.

Discussion

Octreotide remains the drug of choice in managing MBO. Ranitidine was used in one randomized trial in all participants and so its effectiveness as a single drug is not known until there is a randomized comparison with octreotide. Antiemetics such as metoclopramide and olanzapine may be effective, but we have very few randomized trials of antiemetics in MBO.

Conclusion

The panel recommends octreotide in non-operable MBO. Randomized trials are needed to clarify ranitidine and antiemetic choices.

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Authors and Affiliations

  1. Geisinger Health System, Danville, PA, USA

    Mellar Davis

  2. Department of Palliative, Rehabilitation and Integrative Medicine, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    David Hui & Eduardo Bruera

  3. Trinity College Dublin, University College Dublin, and Our Lady’s Hospice Dublin, Dublin, Ireland

    Andrew Davies

  4. Supportive Care in Cancer Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, Onco-Haematology, Milan, Italy

    Carla Ripamonti & Giulia DeFeo

  5. Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO) and Centro Hospitalar Vila Nova de Gaia, Espinho, Portugal

    Andreia Capela

  6. Palliative Care Endowed Chair Division of Hematology, Oncology & Palliative Care Virginia Commonwealth University Massey Cancer Center, Richmond, VA, USA

    Egidio Del Fabbro

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Contributions

Systematic search: Mellar Davis, David Hui; manuscript development and writing: Mellar Davis, Andrew Davies; editing and critiquing: David Hui, Andrew Davies, Carla Ida Ripamonti, Andreia Capela, Giulia DeFeo, Egidio Del Fabbro, Eduardo Bruera.

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Davis, M., Hui, D., Davies, A. et al. Medical management of malignant bowel obstruction in patients with advanced cancer: 2021 MASCC guideline update. Support Care Cancer 29, 8089–8096 (2021). https://doi.org/10.1007/s00520-021-06438-9

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