Management of bone painful metastases

Bone is the thirdmost common site of metastatic cancer after lung and liver. It becomes painful in 70% and may significantly impair the cancer patient's quality of life. The pathophysiology of pain due to bone metastasis in now better understood. The character of painful bone includes both inflammatory and neuropathic features.Different and many therapeutic options are available. It is important to know the different options of treatment in order to select the appropriate treatment for the individual patient. However multimodal approach is often necessary and includes medical treatment [analgesics, bisphosphonates anddenosumab] and non-medicalsuch us radiotherapy and cementoplasty Analgesics include three levels of WHO and will be indicated depending on the pain intensity. Bisphosphonates and denosumab decrease bone resorption by acting on osteoclasts and have demonstrated analgesic effect particularly in prostate cancer with bone metastases. Radiotherapy provides an analgesic effect resulting from the radiotoxic effect directly on tumor cells and inflammatory reaction of the boneenvironment. While external beam radiotherapy is the treatment of choice to treat pain from localized bone metastases, Radiopharmaceuticals by their systemic action is better suited in case of extensive metastases. Cementoplasty consist in injecting cement into the injured vertebral body injured but its analgesic role remains unproven. Anti-cancer therapy should be reviewed when the tumor is responsive. The therapeutic approach should be individualized for each patient and requires an understanding of the mechanisms of cancer pain. At present, there is no algorithm of choice between the different therapeutic modalities. The treatment must be discussed within a multidisciplinary working team with specialists of cancer, a nuclear physician, an intensivist, a surgeon and a palliative care physician

Comparative study of princeps drugs dissolution of metformin commercialied in African countries

This study is presented to raise the awareness concerning the problems of the quality of princeps drugs used in developing countries. Its goal is to show that a drug is the result of a complex balance between a number of parameters and that, for the same active principle, the therapeutic effectiveness is conditioned by the pharmacotechnic characteristics, by the formulation in its galenic form and by manufacturing conditions. The comparison of the in vitro release of metformine from princeps products originating from different countries reveals pharmacotechnic differences: a delayed dissolution suggests a risk of reduction in effectiveness and an early dissolution a risk of overdose. Thus, the dissolution test applied to generic drugs could be of interest in the comparison between different princeps of a same active principle