Cancer Treatment Today » Pain Treatment

Cymbalta for oxaliplatin induced neuropathy – pro

M Levin, MD — Sun, 26 Aug 2012 04:22:27 +0000

Oxaliplatin induced neuropathy can be difficult to manage. Two recent phase II studies suggested that Cymbalta(duloxetine) is effective for oxapliplatin induced neuropathy. Both studies were in small number of patients and there was a significant monority of patients who did not tolerate treatment. Overall benefit was modest. Both studies concluded that using this drug is feasible. This was followed by an abstract at 2012 ASCO meeting of a phase III trial. This was a placebo controlled crossover trial. It found that there was no difference in duloxetine efficacy based on the specific neurotoxic agent received. Severe (Grade 3) non-hematologic toxicity was reported by 11%, and 41% reported moderate (Grade 2) toxicities. The incidence of Grade 2+ fatigue, the most commonly reported side effect, was significantly higher in the duloxetine arm as compared to placebo (11% vs. 3%, p = 0.029). It concluded that duloxetine 60mg daily is an efficacious and well-tolerated intervention for the treatment of taxane or platinum-related painful CIPN.

This trial raised more questions than it answers. It does not prove that Cymbalta is uniquely beneficial for oxaliplaitn induced neuropathy and toxicity was significant. It was a comparison against placebo, not another analgesic or anti-depressant. Clearly, comparative studies are needed before it can be considered standard of care.

C. Teng, H. Teng, Y. Yang, C. Yen, T. Lin, J. Lin, W. Chen, C. Tzeng, W. Wang; Department of Medicine, National Yang-Ming University Hospital and Taipei Veterans General Hospital, Yilan, Taiwan; Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, Taipei City Hospital Renai Branch, Taipei, Taiwan; Taipei Veterans General Hospital, Taipei, Taiwan; Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University Hospital, Yilan, Taiwan Use of duloxetine for oxaliplatin-induced neuropathic pain in patients with colorectal cancer: An open-label pilot study. Clin Oncol 29: 2011 (suppl; abstr e19644)

Ya-Hsu Yang, Jen-Kou Lin, Wei-Shone Chen, Tzu-Chen Lin, Shung-Haur Yang, Jeng-Kai Jiang, Shih-Ching Chang, Yuan-Tzu Lan, Chun-Chi Lin, Chueh-Chuan Duloxetine improves oxaliplatin-induced neuropathy in patients with colorectal cancer: an open-label pilot study
Supportive Care in Cancer July 2012, Volume 20, Issue 7, pp 1491-1497 Ya-Hsu Yang, Jen-Kou Lin

Ellen M. Lavoie Smith, Herbert Pang, Constance Cirrincione, Stewart Barry Fleishman, Electra D. Paskett, Camilo E. Fadul, Chetaye Knox, Charles L. Shapiro, Paul Gilman, Cancer and Leukemia Group B; University of Michigan, Ann Arbor, MI; Duke University, Durham, NC; Alliance Statistical Center, Duke University, Durham, NC; Continuum Cancer Centers of New York, Beth Israel and St. Luke’s-Roosevelt, New York, NY; The Ohio State University Comprehensive Cancer Center, Columbus, OH; Dartmouth-Hitchcock Medical Center, Lebanon, NH; Illinois Oncology Research Association, Peoria, IL; The Ohio State University, Columbus, OH; Main Line Hematology and Oncology Associates, Wynnewood, PA CALGB 170601: A phase III double blind trial of duloxetine to treat painful chemotherapy-induced peripheral neuropathy (CIPN). Citation:
J Clin Oncol 30, 2012 (suppl; abstr CRA9013)

For Lay version see here

Subutex and Suboxone for Addiction

M Levin, MD — Fri, 10 Aug 2012 00:42:25 +0000

Buprenorphin comes in a formulation that can be taken via patch thorugh the skin or under the tongue. In October 2002, the Food and Drug Administration (FDA) approved buprenorphine monotherapy product, Subutex®, and a buprenorphine/naloxone combination product, Suboxone®, for use in narcotic addiction treatment. IT saturates narcotic receptors and prevents a “high”. The combination product is designed to decrease the potential for abuse by injection.

The transdermal form is already well-established for treatment of chronic cancer pain. It was recommended for this purpose by a consensus conference(Pergolizzin et al). The sublingual form is much less studied in this setting. Notably, studiedas logn ago as 1979 by Robbie. He concluded that this sublingual preparation seems worthy of addition to the commercially available range of analgesics in clinical practice. Other publications appeared occasionally over the next 20 years and have been generally supportive. In 2005, Malinoff found it to be well tolerated and safe and appeared to be effective in the treatment of chronic pain patients refractory to other pain medications. It continued to be mildly recommended in more recent reviews.

Read the Professional version here.

Subutex and Suboxone for Addiction – pro

M Levin, MD — Fri, 10 Aug 2012 00:39:43 +0000

Buprenorphin comes in a sublingual and transdermal formulation. In October 2002, the Food and Drug Administration (FDA) approved buprenorphine monotherapy product, Subutex®, and a buprenorphine/naloxone combination product, Suboxone®, for use in opioid addiction treatment. The combination product is designed to decrease the potential for abuse by injection.

The transdermal form is well-established for treatment of chronic cancer pain and. It was recommended for addiction purpose by a consensus conference(Pergolizzin et al). The sublingual form is much less studied in this setting. Notably, it was studied as long ago as 1979 by Robbie. He concluded that this sublingual preparation seems worthy of addition to the commercially available range of analgesics in clinical practice. Other publications appeared occasionally over the next 20 years and have been generally supportive. in 2005, Malinoff found it to be well tolerated and safe and appeared to be effective in the treatment of chronic pain patients refractory to other pain medications. It continued to be mildly recommended in more recent reviews.

Pergolizzi JV Jr, Mercadante S, Echaburu AV, Van den Eynden B, Fragoso RM, Mordarski S, Lybaert W, Beniak J, Orońska A, Slama O; Euromed Communications meeting.Curr Med Res Opin. 2009 Jun;25(6):1517-28.

D. S. Robbie A trial of sublingual buprenorphine in cancer pain. Br J Clin Pharmacol. 1979; 7(Suppl 3): 315S–317S.

Hotz G. Oral and maxillofacial cancer pain therapy with sublingual buprenorphine.Schmerz. 1988 Mar;2(1):38-41.

Malinoff HL, Barkin RL, Wilson G. Sublingual buprenorphine is effective in the treatment of chronic pain syndrome.Am J Ther. 2005 Sep-Oct;12(5):379-84.

Yokell MA, Zaller ND, Green TC, Rich JD. Buprenorphine and buprenorphine/naloxone diversion, misuse, and illicit use: an international review.Curr Drug Abuse Rev. 2011 Mar 1;4(1):28-41.

Opioids and the management of chronic severe pain in the elderly: consensus statement of an International Expert Panel with focus on the six clinically most often used World Health Organization Step III opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone). Pain Pract. 2008 Jul-Aug;8(4):287-313.

Pergolizzi J, Böger RH, Budd K, Dahan A, Erdine S, Hans G, Kress HG, Langford R, Likar R, Raffa RB, Sacerdote P. The role of transdermal buprenorphine in the treatment of cancer pain: an expert panel consensus.Pain Pract. 2008 Jul-Aug;8(4):287-313.

Read the Layperson version here.

Suboxone, a Sublingual Preparation of Buprenorphine in Treatment of Chronic Cancer Pain – pro

M Levin, MD — Tue, 19 Jun 2012 21:14:52 +0000

The transdermal form is well-established for treatment of chronic cancer pain and. It was recommended for this purpose by a consensus conference(Pergolizzin et al). The sublingual form is much less studied in this setting. Notably, it was started as longer go us 1979 by Robbie. He concluded that this sublingual preparation seems worthy of addition to the commercially available range of analgesics in clinical practice. Other publications appeared occasionally over the next 20 years and have been generally supportive. in 2005, Malinoff found it to be well tolerated and safe and appeared to be effective in the treatment of chronic pain patients refractory to other pain medications. It continued to be mildly recommended in more recent reviews.

D. S. Robbie A trial of sublingual buprenorphine in cancer pain. Br J Clin Pharmacol. 1979; 7(Suppl 3): 315S–317S.

Hotz G. Oral and maxillofacial cancer pain therapy with sublingual buprenorphine.Schmerz. 1988 Mar;2(1):38-41.

Malinoff HL, Barkin RL, Wilson G. Sublingual buprenorphine is effective in the treatment of chronic pain syndrome.Am J Ther. 2005 Sep-Oct;12(5):379-84.

Yokell MA, Zaller ND, Green TC, Rich JD. Buprenorphine and buprenorphine/naloxone diversion, misuse, and illicit use: an international review.Curr Drug Abuse Rev. 2011 Mar 1;4(1):28-41.