Abstract
Purpose
Bortezomib, a proteasome inhibitor drug very effective against multiple myeloma, may induce the so-called bortezomib-induced peripheral neuropathy (BIPN), hardly manageable with common analgesic drugs. This study assessed the effectiveness of controlled-release (CR) oral oxycodone in controlling pain and its interference on daily functions of patients with hematologic malignancies affected by BIPN.
Methods
Forty-six patients (median age, 62 years) affected by myeloma and lymphoma, complaining of BIPN-related pain of moderate-to-severe intensity and unresponsive to previous analgesic treatments, were treated with CR oxycodone. The intensity of continuous and brief pain (BP) along with interference of pain with the common daily dimensions of feeling and function were evaluated by using an 11-point numerical rating scale (NRS); a global patient evaluation of efficacy was also performed.
Results
The daily average dose of CR oxycodone administered was 28.46 mg (range, 20–80 mg). The pain intensity decreased from a mean NRS value of 7.6 at baseline to 1.3 on day 14. The frequency of BP was reduced from 61 to 47 % of patients and its intensity from 7.4 to 3.1 NRS score. A similar trend to decreasing values was observed for all the daily life functions. Slight- or mild-intensity side effects were observed in 23 patients (51 %). At the end of the study, 75 % of patients found the treatment effective or very effective.
Conclusion
CR oxycodone for relief of BIPN-related pain was effective and well tolerated. The pain control significantly improved also the quality of the daily life functions, which are usually compromised in these suffering patients.
References
Niscola P, Cartoni C, Romani C, Brunetti GA, D'Elia GM, Cupelli L, Tendas A, de Fabritiis P, Mandelli F, Foà R (2007) Epidemiology, features and outcome of pain in patients with advanced hematological malignancies followed in a home care program: an Italian survey. Ann Hematol 86(9):671–676
Niscola P, Arcuri E, Giovannini M, Scaramucci L, Romani C, Palombi F, Trapè G, Morabito F (2004) Pain syndromes in haematological malignancies: an overview. Hematol J 5(4):293–303
Niscola P, Romani C, Cartoni C, Cupelli L, Piccioni D, Dentamaro T, Tendas A, Giovannini M, Scaramucci L, Tolu B, Perrotti AP, de Fabritiis P (2008) Epidemiology of pain in hospital haematological setting: an Italian survey. Leuk Res 32(1):197–198
Jensen TS, Gottrup H, Sindrup SH, Bach FW (2001) The clinical picture of neuropathic pain. Eur J Pharamacol 429:1–11
Chaudhry V, Cornblath DR, Polydefkis M, Ferguson A, Borrello I (2008) Characteristics of bortezomib- and thalidomide-induced peripheral neuropathy. J Peripher Nerv Syst 13(4):275–282
Argyriou AA, Iconomou G, Kalofonos HP (2008) Bortezomib-induced peripheral neuropathy in multiple myeloma: a comprehensive review of the literature. Blood 112(5):1593–1599
Richardson PG, Briemberg H, Jagannath S, Wen PY, Barlogie B, Berenson J, Singhal S, Siegel DS, Irwin D, Schuster M, Srkalovic G, Alexanian R, Rajkumar SV, Limentani S, Alsina M, Orlowski RZ, Najarian K, Esseltine D, Anderson KC, Amato AA (2006) Frequency, characteristics, and reversibility of peripheral neuropathy during treatment of advanced multiple myeloma with bortezomib. J Clin Oncol 24(19):3113–3120
San Miguel JF, Schlag R, Khuageva NK (2008) Bortezomib plus melphalan and prednisone for initial treatment of multiple myeloma. N Engl J Med 359:906–917
Gerecitano J, Portlock C, Moskowitz C, Hamlin P, Straus D, Zelenetz AD, Zhang Z, Dumitrescu O, Sarasohn D, Lin D, Pappanicholaou J, Cortelli BM, Neylon E, Hamelers R, Wright J, O'Connor OA (2009) Phase 2 study of weekly bortezomib in mantle cell and follicular lymphoma. Br J Haematol 146(6):652–655
Cavaletti G, Gilardini A, Canta A, Rigamonti L, Rodriguez-Menendez V, Ceresa C, Marmiroli P, Bossi M, Oggioni N, D'Incalci M, De Coster R (2007) Bortezomib-induced peripheral neurotoxicity: a neurophysiological and pathological study in the rat. Exp Neurol 204(1):317–325
Cata JP, Weng HR, Burton AW, Villareal H, Giralt S, Dougherty PM (2007) Quantitative sensory findings in patients with bortezomib-induced pain. J Pain 8(4):296–306
Treede RD, Jensen TS, Campbell JN, Cruccu G, Dostrovsky JO, Griffin JW, Hansson P, Hughes R, Nurmikko T, Serra J (2008) Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology 29;70(18):1630–1635
Cavaletti G, Nobile-Orazio E (2007) Bortezomib-induced peripheral neurotoxicity: still far from a painless gain. Haematologica 92(10):1308–1310
Jagannath S, Durie BG, Wolf JL, Camacho ES, Irwin D, Lutzky J, McKinley M, Potts P, Gabayan AE, Mazumder A, Crowley J, Vescio R (2009) Extended follow-up of a phase 2 trial of bortezomib alone and in combination with dexamethasone for the frontline treatment of multiple myeloma. Br J Haematol 146(6):619–626
Richardson PG, Sonneveld P, Schuster MW, Stadtmauer EA, Facon T, Harousseau JL, Ben-Yehuda D, Lonial S, Goldschmidt H, Reece D, Bladé J, Boccadoro M, Cavenagh JD, Boral AL, Esseltine DL, Wen PY, Amato AA, Anderson KC, San Miguel J (2009) Reversibility of symptomatic peripheral neuropathy with bortezomib in the phase III APEX trial in relapsed multiple myeloma: impact of a dose-modification guideline. Br J Haematol 144(6):895–903
Attal N, Cruccu G, Haanpää M, Hansson P, Jensen TS, Nurmikko T, Sampaio C, Sindrup S, Wiffen P, EFNS Task Force (2006) EFNS guidelines on pharmacological treatment of neuropathic pain. Eur J Neurol 13(11):1153–1169
Dworkin RH, O’Connor AB, Backonja M, Farrar JT, Finnerup NB, Jensen TS, Kalso EA, Loeser JD, Miaskowski C, Nurmikko TJ, Portenoy RK, Rice ASC, Stacey BR, Treede RD, Turk DC, Wallace MS (2007) Pharmacologic management of neuropathic pain: Evidence-based recommendations. Pain 132:237–251
Jensen TS, Madsen CS, Finnerup NB (2009) Pharmacology and treatment of neuropathic pains. Curr Opin Neurol 22(5):467–474
Watson CP, Babul N (1998) Efficacy of oxycodone in neuropathic pain: a randomized trial in postherpetic neuralgia. Neurology 50(6):1837–1841
Watson CP, Moulin D, Watt-Watson J, Gordon A, Eisenhoffer J (2003) Controlled-release oxycodone relieves neuropathic pain: a randomized controlled trial in painful diabetic neuropathy. Pain 105(1–2):71–78
Niscola P, Perrotti AP, del Poeta G, Romani C, Palombi M, Piccioni D, Scaramucci L, Tolu B, Tendas A, Cupelli L, Abruzzese E, D'Elia GM, Brunetti GA, Maurillo L, Giovannini M, Cartoni C, de Fabritiis P (2007) Case reports: zoster pain in haematological malignancies: effective pain relief with oxycodone in patients unresponsive to other analgesic measures. Herpes 14(2):45–47
Gatti A, Sabato AF, Occhioni R, Colini Baldeschi G, Reale C (2009) Controlled-release oxycodone and pregabalin in the treatment of neuropathic pain: results of a multicenter Italian study. Eur Neurol 61(3):129–137
No authors listed. National Cancer Institute: Common Terminology Criteria for Adverse Events v3.0 (CTCAE) Available from http://ctep.cancer.gov/forms/CTCv2
Gilardini A, Marmiroli P, Cavaletti G (2008) Proteasome inhibition: a promising strategy for treating cancer, but what about neurotoxicity? Curr Med Chem 15:3025–3035
Bercovitch M, Adunsky A (2006) High dose controlled-release oxycodone in hospice care. J Pain Palliat Care Pharmacother 20(4):33–39
Niscola P, Scaramucci L, Romani C, Giovannini M, Maurillo L, del Poeta G, Cartoni C, Arcuri E, Amadori S, De Fabritiis P (2006) Opioids in pain management of blood-related malignancies. Ann Hematol 85(8):489–501
Conflict of interest
The authors have no conflict of interest to declare. We declare that we do not have any relationships with pharmaceutical companies, biomedical device manufacturers or other corporations whose products or services may be related to the subject matter of the article. We have full control of all primary data, and we allow the journal to review our data if requested.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Cartoni, C., Brunetti, G.A., Federico, V. et al. Controlled-release oxycodone for the treatment of bortezomib-induced neuropathic pain in patients with multiple myeloma. Support Care Cancer 20, 2621–2626 (2012). https://doi.org/10.1007/s00520-012-1511-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00520-012-1511-y