Different Opioids Provide Similar Control of Cancer Pain

Oral morphine, oxycodone, transdermal fentanyl, and buprenorphine provided similar pain control, response rates, in patients with cancer pain.
Oral morphine, oxycodone, transdermal fentanyl, and buprenorphine provided similar pain control, response rates, in patients with cancer pain.

Oral morphine, oxycodone, transdermal fentanyl, and buprenorphine provided similar pain control, response rates, and safety profiles in patients with cancer pain, a study published in the journal Annals of Oncology has shown.1

Although guidelines tend to consider morphine and morphine-like opioids comparable and interchangeable in the treatment of chronic pain, individual responses can vary. Therefore, researchers sought to compare the analgesic efficacy, changes of therapy, and safety profile over time of 4 strong opioids.

For the multicenter, phase 4 trial, researchers enrolled 520 oncologic patients with moderate to severe pain requiring World Health Organization (WHO) step 3 opioids. Participants were randomly assigned to receive oral morphine, oxycodone, transdermal fentanyl, or buprenorphine for 28 days. At each visit, investigators recorded patients' pain intensity, therapy modifications, and adverse drug reactions.

Results showed that worst and average pain intensity decreased over the 4-week period with no significant differences between the 4 groups. Researchers found that the nonresponse rate ranged from 11.5% in the morphine group to 14.4% with buprenorphine.

The study also demonstrated that each group needed increases in the daily dose, ranging from 32.7% with morphine to 121.2% with transdermal fentanyl. The rate of adjuvant analgesic use ranged from 68.9% with morphine to 81.6% with oxycodone and the rate of drug switches ranged from 12% with oxycodone to 22.1% with morphine.

Continue Reading Below

The rate of treatment discontinuation ranged from 14.5% with fentanyl to 27% with morphine.

In terms of safety, adverse drug events were similar between the 4 drugs, except morphine was significantly associated with greater neurotoxicity.

REFERENCE

1. Corli O, Floriani I, Roberto A, et al. Are strong opioids equally effective and safe in the treatment of chronic cancer pain? A multicenter randomized phase 4 ‘real life' trial on the variability of response to opioids [published online ahead of print March 2, 2016]. Ann Oncol. doi:10.1093/annonc/mdw097.

Loading links....
You must be a registered member of ONA to post a comment.

Sign Up for Free e-newsletters

Regimen and Drug Listings

GET FULL LISTINGS OF TREATMENT Regimens and Drug INFORMATION

Bone Cancer Regimens Drugs
Brain Cancer Regimens Drugs
Breast Cancer Regimens Drugs
Endocrine Cancer Regimens Drugs
Gastrointestinal Cancer Regimens Drugs
Genitourinary Cancer Regimens Drugs
Gynecologic Cancer Regimens Drugs
Head and Neck Cancer Regimens Drugs
Hematologic Cancer Regimens Drugs
Lung Cancer Regimens Drugs
Other Cancers Regimens
Rare Cancers Regimens
Skin Cancer Regimens Drugs