Oxycodone for Cancer-Related Pain

Reid, Colette; Martin, Richard M.; Sterne, Jonathan A C; Davies, Andrew; Hanks, G W

doi:10.1001/archinte.166.8.837

Cited by 93 publications

(16 citation statements)

References 44 publications

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“…One study suggested the possibility of a synergistic effect between morphine and oxycodone as measured by a lower consumption of breakthrough doses [12]. The conclusion of the meta-analysis of RCTs was that the efficacy and tolerability of oxycodone are similar to those of morphine, with no differences demonstrated in patient preference or quality of life [17]. …”

Section: Resultsmentioning

confidence: 99%

Oxycodone and the Challenge of Neuropathic Cancer Pain: A Review

Olarte

2008

Oncology

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In order to evaluate the potential role of oxycodone in cancer pain management, neuropathic cancer pain was selected as a model for difficult pain syndromes. A nonsystematic, yet exhaustive, review of the literature provided the relevant evidence for the discussion. Ten randomized controlled trials (RCTs) and 5 open-label studies on oxycodone and cancer pain, 3 RCTs and 1 open-label study on oxycodone and neuropathic pain, and 2 RCTs on oxycodone and visceral pain were identified and reviewed. Additionally, 5 basic research studies that contributed to our knowledge of the specific mechanisms of action of oxycodone were also reviewed. Finally, recent evidence-based reviews of RCTs on neuropathic pain were selected (6 reviews), and specific RCTs on neuropathic cancer pain were also identified (2 trials). The review of the literature shows that the management of neuropathic cancer pain has changed dramatically in the last few years thanks to new approaches and novel drugs. The vast majority of these new drugs have been proven to be useful in ‘benign’ neuropathic pain syndromes. The intrinsic difficulties in performing RCTs in cancer pain have traditionally justified the acceptance of drugs already known to be effective in benign neuropathic pain, in spite of insufficient evidence in malignant neuropathic pain. Therefore, a case is made for the development of specific guidelines for the management of both simple and complex cases of neuropathic cancer pain. An example of one of such clinical guidelines is provided, in which the role of oxycodone is particularly relevant given the existing evidence.

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Section: Resultsmentioning

confidence: 99%

Oxycodone and the Challenge of Neuropathic Cancer Pain: A Review

Olarte

2008

Oncology

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“…In calculating the number of patients per group we assumed OIC in constipated patients treated with fentanyl to be 40% and in patients treated with morphine sulphate or oxycodone to be 70 and 75% [8]. Based on the receptor-profile and pharmacokinetics of the different opioids [13] we hypothesize that methylnaltrexone will induce successful laxation in 60% of the patients in the morphine group, 60% of the patients in the oxycodone group and in 25% of the patients in the fentanyl group within 4 hours after at least 2 of the first 4 doses (Table 2).…”

Section: Methodsmentioning

confidence: 99%

“…In palliative care for patients with cancer mechanical obstruction by tumor depositions or ascites might also be a cause of constipation, but often constipation is caused by opioid use. The incidence of opioid induced constipation (OIC) is estimated to vary between 35 and 70% of the patients using opioids [4,6-8]. This large range is probably caused by variation in type and dosage of opioids, the amount of (prophylactic) laxatives used and the way patients are monitored for this side effect in different studies [4,6-8].…”

Section: Introductionmentioning

confidence: 99%

“…The incidence of opioid induced constipation (OIC) is estimated to vary between 35 and 70% of the patients using opioids [4,6-8]. This large range is probably caused by variation in type and dosage of opioids, the amount of (prophylactic) laxatives used and the way patients are monitored for this side effect in different studies [4,6-8]. The Rome criteria (currently version III) are generally used to diagnose constipation [5].…”

Section: Introductionmentioning

confidence: 99%

“…First, constipation in palliative care patients may have multiple simultaneously occurring causes, unrelated to opioid therapy. Second, assuming that the constipation of the non-responders is still opioid-induced, one can hypothesize that the response to methylnaltrexone could be determined by the receptor-profile of the specific opioid the patient is using (Table 1) [4,6-8,19]. This is because methylnaltrexone is primarily a μ-receptor antagonist, while not all opioids are solely μ-receptor agonists.…”

Section: Introductionmentioning

confidence: 99%

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Clinical evaluation of the efficacy of methylnaltrexone in resolving constipation induced by different opioid subtypes combined with laboratory analysis of immunomodulatory and antiangiogenic effects of methylnaltrexone

et al. 2014

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BackgroundOpioid-induced constipation (OIC) is one of the major symptoms in palliative care with a prevalence of 30-50%. Methylnaltrexone for the treatment of OIC is significantly more effective than placebo, but only in about fifty percent of the patients regardless of dose increase. Dose increases cause increased toxicity without additional efficacy, and are therefore not recommended.While methylnaltrexone is a μ-receptor antagonist, only a few opioids are solely μ-receptor agonists. Therefore, the response to methylnaltrexone may be determined by the receptor-profile of a specific opioid. In addition, methylnaltrexone may also affect the immune system and angiogenesis as was found in pre-clinical studies. Primary aim of this study is to determine differences in the efficacy of methylnaltrexone prescribed to resolve opioid induced constipation between three commonly used opioid subtypes: morphine sulphate, oxycodone and fentanyl. Secondary aim is to explore potential immunomodulatory and antiangiogenic effects of methylnaltrexone.MethodsIn this multi-center, prospective, parallel group trial we will evaluate the efficacy of methylnaltrexone in resolving OIC occurring as a side effect of the most common opioid subtypes: morphine, oxycodone and fentanyl. In total 195 patients with OIC despite prophylactic laxatives will receive methylnaltrexone every other day up to fourteen days. Patients will report its effect in a laxation diary. Group allocation is based on the opioid type the patient is using. At the start and end of the study period patients complete the Bowel Function Index questionnaire. A subgroup of the patients will donate blood for analysis of immunomodulatory- and anti-angiogenic effects of methylnaltrexone.DiscussionIn this study we aim to determine the efficacy of methylnaltrexone per opioid subtype to reduce constipation. We expect that the outcome of this study will improve the clinical use of methylnaltraxone.Trial registrationThis trial is registered at clinicaltrials.gov: NCT01955213 and in the Dutch trial register: NTR4272.

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