Palliative Management of Inoperable Malignant Bowel Obstruction

Phase 2

Terminated

Brief Summary: To identify the role of palliative medical management of inoperable malignant bowel obstruction (MBO) with Octreotide, Dexamethasone and Metoclopramide given together as triple therapy.

Recruitment & Eligibility

Inclusion Criteria

Age ≥ 18 years of age.
Diagnosis of partial bowel obstruction secondary to active or prior malignancy (primary or metastatic GI, GYN, and carcinomatosis) caused either by tumor itself or adhesions inthe setting of active malignancy.
Cross-sectional imaging performed within 24 hours of clinical symptoms of bowel obstruction (nausea, vomiting, and constipation ± abdominal pain) during hospital admission.
Patient must have an inoperable MBO
Participant must understand the investigational nature of this study and sign an Independent Ethics Committee/Institutional Review Board approved writteninformed consent form prior to receiving any study related procedure.

Exclusion Criteria

Evidence of complete bowel obstruction by imaging.
Bacteremia/septicemia with a documented positive blood culture: If a blood culture comes back positive after study enrollment, patient will be excluded.
Patients already taking a steroid equivalent to 8 mg of dexamethasone per day prior to study enrollment.
Patients undergoing bowel surgery or stent placement for bowel obstruction.
Those patients with MBO in setting of incarcerated hernia.
Known history of QT prolongation syndrome or if QTc is > 450 msec in males or > 470 msec in females on baseline EKG within 2 weeks of enrollment.
Lack of decision making capacity/delirium.
Pregnant or nursing female participants.
Actively suicidal patients.
Acute cholecystitis

Arm && Interventions

Group	Intervention	Description
Treatment (octreotide, dexamethasone, metoclopramide)	Dexamethasone	IV octreotide 300 mcg TID + IV dexamethasone 4 mg BID (first dose 9am and second at 2pm) + IV metoclopramide 10 mg q6h.
Treatment (octreotide, dexamethasone, metoclopramide)	Metoclopramide	IV octreotide 300 mcg TID + IV dexamethasone 4 mg BID (first dose 9am and second at 2pm) + IV metoclopramide 10 mg q6h.
Treatment (octreotide, dexamethasone, metoclopramide)	Octreotide	IV octreotide 300 mcg TID + IV dexamethasone 4 mg BID (first dose 9am and second at 2pm) + IV metoclopramide 10 mg q6h.

Primary Outcome Measures

Name	Time	Method
Proportion of Patients With Obstruction Clearance	Within 7 days of starting protocol therapy	The primary efficacy endpoint is the proportion of eligible patients whose malignant bowel obstruction clears (de-obstruction) within 7 days of starting the protocol therapy. Patients meeting de-obstruction criteria within 7 days will be deemed treatment successes. De-obstruction is defined as: * Effective introduction of oral intake (yes/no) * Distinguished from small volumes of oral fluid that may be allowed with unresolved MBO * Tolerating oral liquid diet (day 1 of de-obstruction) that is able to be progressively more solid (oral or enteral) * Cessation of vomiting or ability for NGT or venting G tube to remain clamped without vomiting Rate of de-obstruction is defined as: - From the date of study enrollment to the first observation of de-obstruction.