Navigating drug use, cessation, and recovery: a retrospective case notes review among sexual minority men at a community-based service in Singapore.

BACKGROUND: In Singapore, where drug use is a highly stigmatized and criminalized issue, there is limited understanding of the challenges faced by individuals, particularly sexual minority men, in their journey towards recovery from substance dependence or addiction. This qualitative study aimed to investigate the driving forces behind drug use, the factors contributing to drug cessation, and the elements influencing the recovery process. METHODS: Data were extracted from clinical records provided by  The Greenhouse Community Services Limited between January 2020 to May 2022. These records encompassed information from four distinct forms: the intake assessment, progress notes, case closing summary, and the care plan review. Thematic analysis was employed to identify and categorize recurring themes within the data. RESULTS: Data from beneficiaries (n = 125) were analyzed and yielded a series of themes related to facilitators of drug use, motivations to cease drug use, and managing one's ongoing recovery. Within the facilitators of drug use, two sub-themes were identified: (a) addressing trauma and triggers and (b) managing emotions. Additionally, managing one's recovery was marked by four significant sub-themes: (a) uncovering personal identities, (b) losing motivation and drive, (c) overcoming obstacles, and (d) preparing for aftercare. CONCLUSIONS: The study contributes valuable insights into the dynamics of ongoing recovery management, offering potential avenues for interventions that could enhance support for individuals in their journey to overcome substance dependence. Enhancing psychoeducation and fostering peer support have the potential to facilitate the recovery process. Clearly, a holistic approach is needed to address these complex issues that cuts across our societies.

Exploring the role of trauma in underpinning sexualised drug use ('chemsex') among gay, bisexual and other men who have sex with men in Singapore.

BACKGROUND: Sexualised drug use (SDU) has been identified as a major risk factor for HIV, as well as other mental health comorbidities among gay, bisexual and other men who have sex with men (GBMSM). While multiple studies have been conducted on the topic, few have explored the role of trauma in underpinning experiences of SDU among substance use treatment-experienced GBMSM. This qualitative study investigates life histories of trauma, and proposes a framework to better situate the factors driving SDU among treatment-experienced GBMSM. METHODS: We conducted semi-structured in-depth interviews with 33 purposively-sampled GBMSM with a history of SDU, and seeking treatment for it in Singapore. Interview topics included participants' experiences and life histories of SDU, substance use, incarceration, trauma, as well as stories of resilience and ongoing recovery from SDU. Interviews were audio-recorded, transcribed, coded, and analysed using inductive thematic analysis, from which a trauma-informed framework was developed. RESULTS: Participants firstly articulated the positive and desired aspects of SDU, such as its utility in allowing them to achieve positive emotional states, sexual enhancement, and feelings of connectedness and intimacy. Participants also described how SDU, in contrast, was used as a coping mechanism to deal with emotional and situational 'precipitants', including dealing with loneliness and a low self-esteem, sexual shame and social anxiety, as well as general stressful situations. Participants also articulated how such precipitants were underpinned by experiences of trauma, including those relating to HIV-related stigma, racism, sexual violence, death and loss, neglect, as well as internalised homophobia. Next, participants illustrated how such trauma were in turn reinforced by several 'preconditions', including the accessibility of substances, emphasis on sexual capital, and lack of access to mainstream support structures in the gay male community, alongside general sociolegal barriers to accessing care. CONCLUSIONS: This study proposes the role of trauma and the preconditions underpinning them in motivating SDU among a sample of largely substance use treatment-experienced GBMSM in Singapore. Interventions that provide support for GBMSM seeking treatment for SDU should provide trauma-informed care to address the complex barriers to treatment effectiveness.

Translational research to realize the full potential of novel agents--an opportunity for vinflunine?

In the past few years, innumerable novel anti-cancer agents have been developed. Some of them have successfully entered into clinical practice while some of them have failed for different reasons. Although, nowadays, cancer treatment still relies heavily on conventional chemotherapy and surgery, with increasing evidence of novel biologic agents which demonstrate its higher anti-cancer activity and fewer side effects, more and more efforts have been spent on development of different types of novel agents. Vinflunine, a novel fluorinated vinca alkaloid, carries mitotic-arresting and tubulin-interacting properties and was just approved for treating transitional cell carcinoma of the urothelial tract (TCCU) in Europe. It, however, took quite a long time to get an approval. Needless to say, TCCU, similar to other types of cancer, is a very complex and heterogeneous disease and therefore, a single drug can hardly eradicate a cancer. Translational research, a new scientific research method, creates a link between clinical and laboratory studies. The link helps us to investigate the change in tumor environment in response to treatment, select patients who are more responsive to a particular treatment and predict prognosis of a group of patients with similar tumor characteristics. It can not only improve the success of a treatment, but also maximize the potential of novel anti-cancer agents.

Survival benefits from lapatinib therapy in women with HER2-overexpressing breast cancer: a systematic review.

Breast cancer is the second cause of cancer mortality worldwide and there is an unmet need for novel anticancer agents. Lapatinib is a novel tyrosine kinase inhibitor for treatment of breast cancer with human epidermal growth factor receptor 2 (HER2) amplification. Given promising results in clinical studies, we investigated the survival benefits of lapatinib use in patients with HER2-overexpressing advanced or metastatic breast cancer. We searched MEDLINE, EMBASE, American Society of Clinical Oncology Meeting proceedings, San Antonio Breast Cancer Symposia proceedings, and the Cochrane Library between 2000 and 2008 for randomized controlled trials where lapatinib was used as single agent or in combination with or following other therapies. Three trials (n=704) met the inclusion criteria. Study quality was assessed by two independent reviewers and meta-analyses were conducted. Significant differences were observed between lapatinib-containing treatments to those without lapatinib in terms of survival. Pooled estimates suggested the hazard ratios of 0.61 [95% confidence interval (CI): 0.50-0.74] for progression-free survival and 0.76 (95% CI: 0.60-0.97) for overall survival. Objective response rate and clinical benefit rate also showed significant differences in favoring the use of lapatinib with odds ratios of 2.15 (95% CI: 1.48-3.11) and 2.23 (95% CI: 1.59-3.12), respectively. Heterogeneity between studies was not observed. In conclusion, addition of lapatinib to conventional anticancer treatment might offer superior survival benefit to patients with advanced metastatic HER2-overexpressing breast cancer. Further investigations on the use of lapatinib in combination with anticancer agents are warranted.

Novel therapeutic strategy for breast cancer: mammalian target of rapamycin inhibition.

BACKGROUND: Mammalian target of rapamycin (mTOR) plays a central role in regulating cellular protein synthesis. Dysregulation of mTOR signaling pathway is strongly associated with tumorigenesis, angiogenesis, tumor progression and drug resistance. Inhibition of mTOR might not only promote cell cycle arrest, but also sensitize resistant cancer cells to chemotherapeutic and other targeted agents. OBJECTIVE: To review and summarize the mechanism of mTOR on regulation of protein synthesis and latest clinical data, and to discuss the novel therapeutic strategy for the use of mTOR inhibitors in the treatment of breast cancer. METHODS: A review of published literatures and conference abstracts obtained from MEDLINE, American Society of Clinical Oncology Meeting and San Antonio Breast Cancer Symposia proceedings for results of previous preclinical and latest clinical studies of mTOR inhibition in breast cancer was performed. CONCLUSIONS: mTOR inhibitors seemed to be potentially useful for the treatment of breast cancer with acceptable safety profile. The challenge remains the identification of suitable candidates with different phenotypes. More structured studies incorporating molecular, clinical and translational research need to be initiated. Future research on mTOR inhibitors for breast cancer should focus on the evaluation of optimal schedule, patient selection and combination strategies to maximize the use of this new class of targeted agents.

Controlled-release oxycodone in the treatment of neuropathic pain of nonmalignant and malignant causes.

OBJECTIVE: To assess the efficacy and safety of controlled-release oxycodone in patients with moderate to severe neuropathic pain of nonmalignant and malignant causes. METHODS: A retrospective observational study on the use of controlled-release oxycodone for patients with moderate to severe neuropathic pain. Records of patients treated at the Davao Doctor's Oncology Center Pain Clinic from June 2005 to June 2007 were reviewed. Sixty-seven patients with moderate to severe neuropathic pain despite treatment with adjuvant analgesics (anticonvulsants and antidepressants), who therefore received controlled-release oxycodone, were identified: 35 patients had neuropathic pain not related to a malignancy, and 32 patients had neuropathic pain secondary to a malignancy. Baseline pain intensity and pain intensity on follow-up after 2-4 weeks of treatment were recorded using a Visual Analog Scale. RESULTS: Among patients with nonmalignant neuropathic pain, the baseline Visual Analog Scale score was 8-10/10, with improvement in pain score to 0-2/10 in 96% on follow-up. Average daily dose of oxycodone was 25 mg/day. Patients received concomitant anticonvulsants or antidepressants. Duration of treatment ranged from 2 to 8 months. Among patients with malignant neuropathic pain, the baseline Visual Analog Scale score was 10/10 with improvement to 2-4/10. Average daily dose was 40 mg per day. Patients received concomitant anticonvulsants. Duration of treatment ranged from 1 to 4 months. Oxycodone was well tolerated, with dizziness and nausea occurring only in <5%. No respiratory depression occurred. DISCUSSION/CONCLUSION: The use of opioids for neuropathic pain is not fully accepted by the majority of physicians at present. This study shows that controlled-release oxycodone is a safe, well-tolerated and effective medication for neuropathic pain.

Vinflunine: clinical perspectives of an emerging anticancer agent.

BACKGROUND: Vinflunine is a novel second generation of Vinca alkaloid. The binding of vinflunine to tubulin and subsequent cellular arrest in mitosis is the core mechanism of this antineoplastic agent. In addition, its potential vascular-disrupting and antiangiogenic activities uphold further clinical development of this compound. OBJECTIVE: To review and summarise the pharmacological and latest clinical data, and discuss the impact of vinflunine on current treatment regimens. METHODS: A review of published literature and conference abstracts for results of previous preclinical and latest clinical studies in all cancer types was performed. RESULTS/CONCLUSIONS: Noteworthy results from Phase II studies for treatment of non-small cell lung cancer (NSCLC), breast cancer and bladder cancer supported Phase III studies. One of the Phase III studies for treatment of advanced NSCLC showed important results. Encouraging results of combination use of vinflunine and other biologic agents also opened areas to investigate its synergistic or auxiliary role to existing therapies.