Randomized Trial of Low-Dose Morphine Versus Weak Opioids in Moderate Cancer Pain

Bandieri, Elena; Romero, Marilena; Ripamonti, Carla; Artioli, Fabrizio; Sichetti, Daniela; Fanizza, Caterina; Santini, Daniele; Cavanna, Luigi; Melotti, Barbara; Conte, Pierfranco; Roila, Fausto; Cascinu, Stefano; Bruera, Éduardo; Tognoni, Gianni; Luppi, Mario

doi:10.1200/jco.2015.61.0733

Cited by 156 publications

(92 citation statements)

References 28 publications

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“…Of the 41 patients who underwent radical cystectomy in the study by Balar et al . 86 , 26 (63.4%) had <pT2N0 disease and, importantly, the vascular toxicity was similar to that observed in neoadjuvant trials of standard-dose GC chemotherapy. In an intention-to-treat analysis (with patients who refused radical cystectomy counted as nonresponders), the <pT2N0 rate was 56.5% 86 .…”

Section: Improving On Standard Nact With Mvacsupporting

confidence: 71%

“…On the basis of the promising activity and toxicity profiles of dose-dense GC (ddGC) compared with that of ddMVAC reported in the metastatic setting 84 (TABLE 3), two prospective, multicentre phase II studies of neoadjuvant ddGC (2-week cycle) chemotherapy in patients with MIBC have been initiated and reported in abstract form 85,86 . Plimack et al 85 reported that, among the first 13 patients treated in one of these trials, two patients had a myocardial infarction resulting in congestive heart failure, one had a deep venous thrombosis (DVT), one had a pulmonary embolus, and one required coronary artery bypass grafting before surgical resection of the tumour 85 .…”

Section: Improving On Standard Nact With Mvacmentioning

confidence: 99%

“…Of the 31 patients who underwent radical cystectomy, 14 (45%) had <pT2N0 disease and 10 (32%) had a pCR 85 . In the second, more-recent, trial, Balar et al 86 excluded patients with any recent history of a cardiovascular event from the outset, used a higher dose of gemcitabine than that used by Plimack et al . 85 (2,500 mg/m 2 versus 1,200 mg/m 2 ), and administered split-dose cisplatin (35 mg/m 2 on day 1 and 2) instead of the standard single dose (70 mg/m 2 on day 1).…”

Section: Improving On Standard Nact With Mvacmentioning

confidence: 99%

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Systemic, perioperative management of muscle-invasive bladder cancer and future horizons

Funt

Rosenberg

2016

Nat Rev Clin Oncol

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Many patients diagnosed with muscle-invasive bladder cancer (MIBC) will develop distant metastatic disease. Over the past three decades, perioperative cisplatin-based chemotherapy has been investigated for its ability to reduce the number of deaths from bladder cancer. Insufficient evidence is available to fully support the use of such chemotherapy in the adjuvant setting; however, neoadjuvant cisplatin-based combination chemotherapy has become a standard of care for eligible patients based on the improved disease-specific and overall survival demonstrated in two randomized phase III trials, compared with surgery alone. For patients with disease downstaging to non-MIBC at the time of radical cystectomy as a result of neoadjuvant chemotherapy, outcomes are outstanding, with 5-year overall survival of 80–90%. Nevertheless, the inability to define before treatment the patients who will and those who will not achieve such a response has impeded the achievement of better outcomes for patients with MIBC. High-throughput DNA and RNA profiling technologies might help to overcome this barrier and enable a more-personalized approach to the use of cytotoxic neoadjuvant chemotherapy. In the past 2 years, trial results have demonstrated the unprecedented ability of immune-checkpoint blockade to induce durable remissions in patients with metastatic disease that has progressed after chemotherapy; studies are now urgently needed to determine how best to incorporate this powerful therapeutic modality into the care of patients with MIBC. Herein, we review the evolution of chemotherapy and immunotherapy for muscle-invasive bladder cancer.

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Section: Improving On Standard Nact With Mvacsupporting

confidence: 71%

Section: Improving On Standard Nact With Mvacmentioning

confidence: 99%

Section: Improving On Standard Nact With Mvacmentioning

confidence: 99%

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Systemic, perioperative management of muscle-invasive bladder cancer and future horizons

Funt

Rosenberg

2016

Nat Rev Clin Oncol

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“…Since 1986, the WHO three-step ‘ladder’ has recommended weak opioids for patients with moderate pain 26. Recent researches have revealed that passing directly from step I to step III of the WHO analgesic ladder is more efficient than the traditional three-step strategy for mild–moderate chronic cancer pain 25 26.…”

Section: Discussionmentioning

confidence: 99%

Consumption trend and prescription pattern of opioid analgesics in China from 2006 to 2015

Fang

Liu

et al. 2018

Eur J Hosp Pharm

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ObjectivesTo investigate the consumption trend and prescription pattern of opioids in China from 2006 to 2015, and compare the results with those of selected countries and regions, and identify the pain relief level of China.MethodsNine different opioid drugs were included in our survey, based on the whole population of China. Consumption of each type of opioid was calculated in grams in reports of the Chinese Food and Drug Administration and the International Narcotics Control Board. Then it was converted to the terms of defined daily doses and morphine equivalents. The correlation between consumption of opioids and gross domestic product, human development index and cancer incidence was analysed by Pearson’s correlation test.ResultsDefined daily doses increased by 7.89% per year since 2006, and reached 91.05 in 2015. Morphine equivalents increased by 10.57% per year since 2006, and reached 7.24 g in 2015. The average defined daily doses and morphine equivalents were 85.44 and 5.70 g respectively in 2006–2015. Annual defined daily doses of China were lower than the global average. Consumption was related to gross domestic product, but not human development index and cancer incidence. Furthermore, defined daily doses varied greatly in countries with similar gross domestic product or the human development index. Strong opioids or non-intravenous opioids always constituted the majority of opioids, and sustained an increasing tendency in consumption. The predominantly prescribed opioids were fentanyl and morphine. Consumption of oxycodone had a tendency to increase, whereas pethidine tended to decrease.ConclusionConsumption of opioids has shown an increasing tendency and in the meantime the prescription pattern has changed, indicating the progress of pain relief in China, though it remained far lower than the average global level.

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“…If the pain improves, the dose should be calculated for 24 h and divided into 4-6 h intervals [40]. In a recent randomized trial, Bandieri et al [42] concluded that in patients with cancer and moderate pain, low-dose morphine significantly reduced the intensity of pain compared with weak opioids, with similarly good tolerability and an earlier effect.…”

Section: • Morphinementioning

confidence: 99%

Latin-American Guidelines for Cancer Pain Management

Lara-Solares

Olea²,

Pinos

et al. 2017

Pain Manag.

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Practice points• Adequate pain management starts with an appropriate syndromic diagnosis based on a detailed clinical history, comprehensive physical examination and correct interpretation of additional medical tests.• Appropriate syndromic classification of pain is based on its clinical characteristics, as well as on a meticulous assessment of the intensity of pain by applying standard scales. The patient's psychosocial situation must be taken into account when attempting to optimize management and predict the response to treatment.• As with all types of chronic pain, assessment of patients with cancer pain should take into account the individual profile of the patient (age, comorbidities, functionality, previous exposure to drugs such as opioids and polypharmacy) and the type, intensity and potential clinical course of the pain. Only thus will it be possible to decide on the best approach, based on aspects such as efficacy, safety, tolerability and cost. Multimodal strategies are the most successful.• Multimodal approaches include interventional, psychological, rehabilitative and integrative therapies.• Various formulations of fentanyl have been reported for the treatment of breakthrough pain, as follows: transmucosal, intranasal, sublingual, buccal tablets and gingival. However, these formulations are not available in Latin America.• In Latin America, the WHO guidelines have proven critical for justifying to local governments the key role of opioids such as morphine and the need for an adequate supply. Nevertheless, availability of opioids in the region remains poor.• Treatment of severe pain should be with a strong opioid, in most cases with oral formulations. Other routes (intravenous, subcutaneous, spinal (epidural and intrathecal) may only be necessary in refractory cases.• Extended-release opioids (morphine, oxycodone and hydromorphone) can be supplemented with immediate-release formulations as needed. Assessment of comorbidities is essential when deciding on the best option.For reprint orders, please contact: reprints@futuremedicine.com

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Randomized Trial of Low-Dose Morphine Versus Weak Opioids in Moderate Cancer Pain

Cited by 156 publications

References 28 publications

Systemic, perioperative management of muscle-invasive bladder cancer and future horizons

Systemic, perioperative management of muscle-invasive bladder cancer and future horizons

Consumption trend and prescription pattern of opioid analgesics in China from 2006 to 2015

Latin-American Guidelines for Cancer Pain Management

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