Tratamiento con fentanilo sublingual del dolor irruptivo asociado a reacciones alérgicas durante la infusión de quimioterapia / Sublingual fentanyl for the treatment of breakthrough cancer pain during allergic reactions to chemotherapy infusion

Introducción: Las reacciones de hipersensibilidad a fármacos (RHF) son eventos potencialmente mortales que se producen durante la administración de diversos agentes quimioterápicos. Pueden cursar con un dolor intenso, considerado en algunos casos como dolor irruptivo oncológico (DIO). Actualmente no existen guías para el tratamiento de este tipo específico de dolor. Objetivos: Evaluar, en pacientes oncológicos, la eficacia del citrato de fentanilo sublingual 100 mcg en el tratamiento del DIO asociado a RHF durante la infusión de quimioterapia. Material y métodos: Estudio retrospectivo con pacientes que recibieron quimioterapia en el servicio de Oncología Médica del Hospital de Denia entre 2013 y 2016 y que fueron tratados con fentanilo por DIO asociado a RHF (EVA > 7). Se estableció la gravedad del DIO mediante una escala EVA antes y después de administrar fentanilo. Se utilizó la t de Student para comparar las puntuaciones EVA antes y después del tratamiento. Resultados: En total, se incluyeron 34 pacientes (73,53 % mujeres, edad media 59,68 años). Los tratamientos quimioterápicos asociados a una mayor frecuencia a la aparición de DIO por RHF fueron docetaxel y oxaliplatino (ambos 35,29 %), seguidos de paclitaxel (20,59 %). En promedio, los pacientes tuvieron un valor basal de EVA de 8,55 (DE 0,79) antes de ser tratados con fentanilo. Tras el tratamiento, la intensidad media del dolor fue de 1,48 (DE 1,50), siendo la diferencia significativa (p < 0,001). La duración media del episodio de DIO fue de 5,29 minutos (DE 2,25), y el tiempo medio hasta el inicio del alivio del dolor de 1,52 minutos (DE 0,71). Conclusiones: Fentanilo sublingual es un fármaco efectivo en el manejo del DIO asociado a RHF durante la infusión de taxanos y oxaliplatino, donde permite un alivio rápido y signifi cativo del dolor. Se debe seguir investigando su papel en este contexto mediante ensayos clínicos controlados

Introduction: Drug hypersensitivity reactions (DHR) are events that can occur during the administration of several chemotherapeutic agents and which could potentially be life-threatening. These events may present with intense pain, in some cases known as breakthrough cancer pain (BTCP). There are no currently available treatment guidelines for this specifi c type of pain. Objectives: To assess the effi cacy of sublingual fentanyl citrate 100 mcg in cancer patients in the treatment of DHR-related BTCP during chemotherapy infusion. Material and methods: A retrospective study with patients receiving chemotherapy in the Medical Oncology Department of Hospital de Denia between 2013 and 2016 who were treated with fentanyl due to DHR-related BTCP (VAS [Visual Analogue Scale] > 7). BTCP severity was determined via a VAS before and after fentanyl administration. Student's t-test was used to compare VAS scores before and after the treatment. Results: A total of 34 patients were included (73.53 % women; mean age: 59.68 y/o). The chemotherapy treatments that were most frequently associated with the occurrence of DHR-related BTCP were docetaxel and oxaliplatin (both 35.29 %), followed by paclitaxel (20.59 %). On average, patients had a baseline VAS score of 8.55 (SD 0.79) before being treated with fentanyl. After treatment, the mean pain intensity was 1.48 (SD 1.50), which represented a signifi cant difference (p < 0.001). The mean duration of the BTCP episode was of 5.29 minutes (SD 2.25), and the mean time to achieve pain relief was 1.52 minutes (SD 0.71). Conclusions: Sublingual fentanyl is an effective drug in the management of DHR-related BTCP during the infusion of taxanes and oxaliplatin, as it provides for a rapid and significant pain relief. Its role in this context should be further investigated by means of controlled clinical trials

Variability of carboplatin dose calculation methods in Spain.

OBJECTIVE: To describe and analyze the variability in carboplatin dosing strategies in Spanish hospitals. METHODS: We designed a questionnaire consisting of 19 multiple-choice items structured in two sections (hospital characteristics and carboplatin dosing data). The questionnaire was sent by e-mail to all the oncology pharmacists included in the register of the Spanish Oncology Pharmacy Group (GEDEFO), and we analyzed the completed questionnaires. RESULTS: Response rate was 33.5% from a total of 185 pharmacy services invited to take part in the survey. All hospitals used the Calvert formula to calculate carboplatin dose with glomerular filtration rate estimated by a formula, most commonly the Cockcroft-Gault equation (80.7%). Carboplatin doses were capped in most hospitals (91.9%): 54.8% capped creatinine clearance at 125 mL/min, 11.3% capped serum creatinine, and 19.3% capped both creatinine clearance and serum creatinine. Serum creatinine cut-off values ranged from 0.36 mg/dL to 1 mg/dL. The most commonly used body weight was actual body weight for underweight, normal weight, and overweight patients. The use of adjusted ideal body weight increased in obese and especially in morbidly obese patients. CONCLUSION: The results from this survey show the variability that exists in carboplatin dose calculation methods among Spanish hospitals and the need to continue investigating to find the optimum dose calculation method and unify criteria to avoid differences between sites that can affect effectiveness and toxicity of carboplatin-containing treatments.