{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T23:30:58Z","timestamp":1772580658362,"version":"3.50.1"},"reference-count":11,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2018,8,31]],"date-time":"2018-08-31T00:00:00Z","timestamp":1535673600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Somatostatin analogs (SSAs) are standard for symptomatic patients with neuroendocrine tumors (NETs). However, most patients experience tachyphylaxis, and limited options exist for this so-called \u201crefractory carcinoid syndrome.\u201d Recently, 5-HT3 antagonist ondansetron has been associated with reduction of bowel movement in a small series. The aim of this analysis was to assess effectiveness of ondansetron for symptomatic treatment of carcinoid syndrome.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design and Patients<\/jats:title>\n                  <jats:p>We have analyzed patients given ondansetron as bridging therapy for refractory carcinoid syndrome. The dose was 2 \u00d7 8 mg for 5 days, followed by reduction to 1 \u00d7 8 mg in case of benefit.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 14 patients with small bowel NETs metastatic to the liver were identified. All patients had been treated with SSAs for a median time of 18 months before aggravation of diarrhea. One patient had to be excluded because of an underlying infectious cause of diarrhea. The median number of daily bowel movements was 7 (range, 5\u201313) before initiation of therapy. At this time, seven patients had stable disease, whereas six patients showed radiological progression with symptomatic breakthrough. All 13 patients were scheduled for salvage therapy. Remarkably, in 85% (11\/13) ondansetron resulted in a clinically relevant decrease of bowel movements to a median of 3 (1\u20134). The median time of ondansetron intake was 29 days (7 days to 29 months). In four patients, diarrhea recurred after initial improvement at an interval of 22\u201343 days, whereas the remaining seven had an ongoing benefit, including two long-term responders who refused further therapy because of pronounced decrease of symptoms (ondansetron for 14+ and 29+ months).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Ondansetron offers symptomatic relief in the majority of patients. Although there was no influence on 5-HIAA levels, evidence from two patients suggests prolonged benefit.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Implications for Practice<\/jats:title>\n                  <jats:p>Somatostatin analogs are standard treatment in patients with carcinoid syndrome and have an overall response rate of up to 50%. This symptomatic benefit, however, is lost in many patients because of the development of tachyphylaxis or tumor progression. Patients with this \u201crefractory carcinoid syndrome\u201d pose a therapeutic challenge and are sometimes faced with a detrimental effect on quality of life. In this article, the authors suggest the 5-HT3 receptor antagonist ondansetron as potential symptomatic therapy for patients with refractory diarrhea due to carcinoid syndrome. Although the number of patients in this retrospective series is limited, treatment was easily applicable, feasible, and safe and resulted in an ongoing symptomatic benefit in 85% of patients, including two long-term responders.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1634\/theoncologist.2018-0191","type":"journal-article","created":{"date-parts":[[2018,8,31]],"date-time":"2018-08-31T14:25:23Z","timestamp":1535725523000},"page":"255-258","source":"Crossref","is-referenced-by-count":14,"title":["Oral Ondansetron Offers Effective Antidiarrheal Activity for Carcinoid Syndrome Refractory to Somatostatin Analogs"],"prefix":"10.1093","volume":"24","author":[{"given":"Barbara","family":"Kiesewetter","sequence":"first","affiliation":[{"name":"Division of Oncology, Department of Internal Medicine I, Medical University Vienna, Vienna, Austria"},{"name":"Neuroendocrine Tumor Unit, Comprehensive Cancer Center Vienna, Medical University Vienna, Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heying","family":"Duan","sequence":"additional","affiliation":[{"name":"Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wolfgang","family":"Lamm","sequence":"additional","affiliation":[{"name":"Division of Oncology, Department of Internal Medicine I, Medical University Vienna, Vienna, Austria"},{"name":"Neuroendocrine Tumor Unit, Comprehensive Cancer Center Vienna, Medical University Vienna, Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Haug","sequence":"additional","affiliation":[{"name":"Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philipp","family":"Riss","sequence":"additional","affiliation":[{"name":"Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University Vienna, Vienna, Austria"},{"name":"Neuroendocrine Tumor Unit, Comprehensive Cancer Center Vienna, Medical University Vienna, Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Selberherr","sequence":"additional","affiliation":[{"name":"Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University Vienna, Vienna, Austria"},{"name":"Neuroendocrine Tumor Unit, Comprehensive Cancer Center Vienna, Medical University Vienna, Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Scheuba","sequence":"additional","affiliation":[{"name":"Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University Vienna, Vienna, Austria"},{"name":"Neuroendocrine Tumor Unit, Comprehensive Cancer Center Vienna, Medical University Vienna, Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Markus","family":"Raderer","sequence":"additional","affiliation":[{"name":"Division of Oncology, Department of Internal Medicine I, Medical University Vienna, Vienna, Austria"},{"name":"Neuroendocrine Tumor Unit, Comprehensive Cancer Center Vienna, Medical University Vienna, Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2018,8,31]]},"reference":[{"key":"2021122506225810700_onco12686-bib-0001","doi-asserted-by":"crossref","first-page":"3063","DOI":"10.1200\/JCO.2007.15.4377","article-title":"One hundred years after \u201ccarcinoid\u201d: Epidemiology of and prognostic factors for neuroendocrine tumors in 35, 825 cases in the United 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Oncol"},{"key":"2021122506225810700_onco12686-bib-0005","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1177\/1758834016675803","article-title":"Refractory carcinoid syndrome: A review of treatment options","volume":"9","author":"Riechelmann","year":"2017","journal-title":"Ther Adv Med Oncol"},{"key":"2021122506225810700_onco12686-bib-0006","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1200\/JCO.2016.69.2780","article-title":"Telotristat ethyl, a tryptophan hydroxylase inhibitor for the treatment of carcinoid syndrome","volume":"35","author":"Kulke","year":"2017","journal-title":"J Clin Oncol"},{"key":"2021122506225810700_onco12686-bib-0007","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1136\/bmj.294.6580.1129","article-title":"Remission of symptoms in carcinoid syndrome with a new 5-hydroxytryptamine M receptor antagonist","volume":"294","author":"Anderson","year":"1987","journal-title":"Br Med J (Clin Res 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