Long-term efficacy and tolerability of intranasal fentanyl in the treatment of breakthrough cancer pain

Abstract

Purpose The aim of the present study was to assess the longterm tolerability and efficacy of intranasal fentanyl (INFS) in opioid-tolerant patients with breakthrough cancer pain (BTP).Patients and methods A 6 months, observational, prospective, cohort study design was employed to follow advanced cancer patients with BTP receiving INFS under routine clinical practice. Eligible adult cancer patients suffering from BTP had been prescribed INFS at effective doses. Data were collected at T0 and at month intervals for six months. The principal outcomes were the evaluation of possible serious adverse effects with prolonged use of INFS, the efficacy of BTP treatment with INFS, the quality of sleep, the rate of INFS discontinuation, and reasons for that.Results Seventy-five patients were surveyed. Thirty-four patients (45.3 %) had a follow-up at 3 months, and twelve patients (16 %) were followed up at 6 months. The mean opioid doses, expressed as oral morphine equivalents, ranged 111-180 mg/day, while the mean INFS doses were 87-119 μg. Adverse effects were reported in a minority of patients and were considered to be associated with opioid therapy used for background pain. The quality of sleep significantly improved during the first 3-4 months. Finally, efficacy based on a general impression regarding the efficacy of INFS was good-excellent in most patients and statistically improved in time up to the third month. Conclusion The long-term use of INFS in advanced cancer patients is effective and safe. No serious adverse effects were found up to six months of assessment. The level of quality of sleep and patients' satisfaction was relatively good, considering the advanced stage of disease.

Adult Cancer Pain, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology

“…66,67 Fentanyl Fentanyl is a highly lipid-soluble mu-opioid receptor agonist that can be administered by the parenteral, spinal, transdermal, transmucosal, buccal, and intranasal routes. 68,69 Transdermal fentanyl is not indicated for rapid opioid titration and should be recommended only after pain is adequately managed by other opioids in opioid-tolerant patients. 70 It is usually the treatment of choice for patients who are unable to swallow, patients with poor tolerance to morphine, and patients with poor compliance.…”

Ocena i leczenie bólu przebijającego u chorych na nowotwory

“…W prospektywnym badaniu przeprowadzonym przez Mercadante i wsp. wśród pacjentów z zaawansowaną chorobą nowotworową wykazano, że produkty fentanylu podawane drogą donosową są dobrze tolerowane i skuteczne w leczeniu epizodów BTCP w długoterminowej terapii [65,66].…”

Transdermal buprenorphine and fentanyl patches in cancer pain: a network systematic review

“… 11 , 18 – 21 Fentanyl is a synthetic, highly lipid-soluble, μ-opioid receptor agonist with a low molecular weight. 11 , 18 , 22 , 23 In contrast to buprenorphine, fentanyl has fast receptor association/dissociation kinetics. 20 Buprenorphine is available as parenteral, sublingual, and TD formulations, whereas fentanyl can be administered by the parenteral, spinal, TD, transmucosal, buccal, and intranasal routes.…”

“… 20 Buprenorphine is available as parenteral, sublingual, and TD formulations, whereas fentanyl can be administered by the parenteral, spinal, TD, transmucosal, buccal, and intranasal routes. 22 , 23 With regard to the TD formulations, TD buprenorphine preparations vary across countries, with either 3–4- or 7-day dosing schedules, depending on preparation availability, while fentanyl has a 3-day dosing schedule.…”