Activated Charcoal for Diarrhea 2004 study
A Phase II Study of Activated Charcoal to Prevent Irinotecan (CPT-11) Induced Diarrhea.
Michael Michael, M Brittain, J Nagai, R Feld, D Hedley, A Oza, L Siu, M J Moore,
Peter MacCallum Cancer Institute, East Melbourne, Australia; Princess Margaret Hospital, University of Toronto, Toronto, Canada.
Abstract: The dose limiting toxicity of CPT-11 is diarrhea. Phase II and III studies of single agent CPT-11 in patients (pts) with colorectal cancer using either 125 mg/m2/ week x4 Q6 weeks or 350 mg/m2 Q3 weeks have reported an incidence of grade 3 or 4 diarrhea of 20-35%.
The current recommendations are for the use of high dose loperamide once diarrhea occurs, as well as dosage reductions in subsequent cycles. One theory for CPT-11-induced diarrhea (CID) is that glucuronidated SN-38 excreted via the biliary tract is converted back to active drug (SN-38) in the small bowel (SB) lumen and has a direct effect on topoisomerase I in the gut mucosa.
The aim of this study was to assess whether adsorbing, by activated charcoal, free SN38 within the SB lumen can reduce CID and hence optimize dose intensity of CPT-11.
Pts studied were those with advanced colorectal cancer receiving CPT-11 125 mg/m2 intravenously over 90 minutes weekly x4 weeks Q6 weeks. On cycle #1 pts received CPT-11 plus activated charcoal-1000 mg in a 15-ml aqueous solution given the evening prior to irinotecan and then TID for the following 48 hours.
In the second cycle of CPT-11 therapy, pts did not receive charcoal. Thus far, 28 pts have completed cycle#1 with the combination of CPT-11 and activated charcoal. Of these 28, there were 24 who then completed a second cycle of CPT-11 without charcoal.
Results: Cycle 1 + Charcoal (n=28):Cycle 2 No Charcoal (n=24) (i) Diarrhea Grade 0,1- 22:14, Grade 2- 4:4, Grade 3- 2:3, Grade 4- 0:3 (ii) Median % planned dose delivered- 98:70, (iii) # pts receiving 90% of planned dose- 18/28:9/24, (iv) # pts taking more than 10 loperamide tablets- 7/28:13/24. On the first cycle of CPT-11, when charcoal was also given, the incidence of severe diarrhea was reduced (2/28 versus 6/24), less anti-diarrheal medication was required and the dose of CPT-11 delivered was higher.
Prophylactic activated charcoal thus may have a role in reducing dose-limiting CID and optimizing CPT-11 therapy: accrual is continuing.
Abstract No: 1615
Subsequently published: J Clin Oncol. 2004 Nov 1;22(21):4410-7.
Is There a Role for Charcoal in Palliative Diarrhea Management?
Helen Senderovich 1 2 3 4, Megan J Vierhout 1 5
Objective: Symptomatic therapy is an intervention centered entirely on symptom management and pain relief. The utilization of charcoal in diarrhea management is a pertinent example of this type of medical care. Diarrhea is an ailment defined as an escalation in the frequency of bowel movements, unformed stool, abdominal discomfort, and pain. These symptoms can be extremely debilitating for patients, and effectuate frustration as well as severely dampening mood and overall well-being. This narrative review aims to explore the use of charcoal in diarrhea management and its possible benefits in alleviating discomfort associated with these symptoms.
Methods: The authors used PubMed, MEDLINE, and Google Scholar searches on recent literature available on the role of activated charcoal in diarrhea management.
Results: It was found that the main precursors of diarrhea include drugs and bacterial infection. Activated charcoal has a firm history in its ability to attract and expel ingested toxins from the gastrointestinal tract. It acts to prevent system absorption of these adverse entities, adsorbing them on the surface of its particles, making it a suitable diarrheal treatment.
Conclusions: Diarrhea can present itself alongside a multitude of treatments and conditions, such as chemotherapy, primary malignancy, intestinal, colorectal and pancreatic cancer, bacterial infection, and irritable bowel syndrome, making activated charcoal a potential therapy in these conditions. In comparison, with other common anti-diarrheal treatments, activated charcoal has exceptionally few side-effects. Overall, further research is necessary in order to wholly determine the effectiveness of charcoal in the management of diarrhea.
Curr Med Res Opin, 34 (7), 1253-1259 Jul 2018