RESUMO
OBJECTIVE: To assess the effectiveness of opioid rotation (OR) to manage cancer pain. To describe the adverse events (AEs) associated with OR. SETTING: Thirty-nine tertiary hospital services. PATIENTS: Sixty-seven oncological patients with cancer-related pain treated at outpatient clinics. INTERVENTION: Prospective multicenter study. Pain intensity was scored using a Numerical Rating Scale (NRS) of 0-10. Average pain (AP) intensity in the last 24 hours, breakthrough pain (BTP), and the number of episodes of BTP on the days before and 1 week after OR were assessed. The pre-OR and post-OR opioid were recorded. The presence and intensity of any AEs occurring after OR were also recorded. RESULTS: In the 67 patients evaluated, 75 ORs were recorded. In all cases, the main reason for OR was poor pain control. Pain intensity decreased by ≥2 points after OR in 75.4 percent and 57.8 percent of cases for AP and BTP, respectively. If the initial NRS score was ≥4, a decrease below <4 accounted for 50.9 percent and 32.3 percent of cases for AP and BTP, respectively. The number of episodes of BTP also decreased significantly (p<0.001). A total of 107 AEs were reported, most of which were mild in intensity, with gastrointestinal symptoms predominating. CONCLUSIONS: Opioid rotation appears to be both safe and effective in the management of basal and breakthrough cancer pain.
Assuntos
Analgésicos Opioides/administração & dosagem , Dor Irruptiva/tratamento farmacológico , Dor Crônica/tratamento farmacológico , Substituição de Medicamentos , Neoplasias/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgésicos Opioides/efeitos adversos , Dor Irruptiva/diagnóstico , Dor Irruptiva/etiologia , Dor Crônica/diagnóstico , Dor Crônica/etiologia , Esquema de Medicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos , Índice de Gravidade de Doença , Espanha , Centros de Atenção Terciária , Fatores de Tempo , Resultado do TratamentoRESUMO
Treatment of a relapsed glioma is a clinical challenge nowadays. New active treatments are required to treat these difficult diseases. Here we present a durable complete remission of a relapsed glioblastoma that has achieved a complete radiologic response with the combination of cetuximab and bevacizumab, in a third-line setting, that has offered a progression-free survival of 20 months. We consider here both potential mechanisms for the explanation of this result. First, the potential target of the cancer stem cells (CSCs) with these two antibodies, and second, the potential recruitment of the immune system to directly pursue the CSCs.
RESUMO
BACKGROUND: Androgen-independent prostate cancer (AIPCA) is a difficult disease to treat. Fulvestrant has shown activity inhibiting estrogen receptor dimerization, and the androgen receptor has been shown to stimulate growth in prostate cancer cell lines. CASE REPORT: A 79-year-old metastatic prostate cancer patient with AIPCA was treated with fulvestrant acetate with a loading dose strategy. Without recording any significant side effects, the prostate-specific antigen (PSA) level decreased from 154 ng/ml to 0.45 ng/ml 8 weeks after the first treatment administration. CONCLUSION: Fulvestrant was able to reduce the PSA level in this AIPC patient without any toxicity.
