Trial Results With Intranasal Fentanyl Hold Promise For Treatment Of Breakthrough Pain In Cancer

Main Category: Pain / Anesthetics
Also Included In: Cancer / Oncology;  Palliative Care / Hospice Care
Article Date: 12 Jun 2007 - 1:00 PDT


A pioneering nasal spray could stop thousands of patients with cancer from suffering unnecessary pain; it was reported today1 at the 10th Congress of the European Association for Palliative Care, Budapest, 7 - 9 June. The study investigated whether this first in class novel formulation could provide fast onset of pain relief and short duration of effect, mirroring the breakthrough pain often experienced by patients with cancer.

The majority of patients with cancer experience chronic pain during the course of their illness.2 However, patients with cancer can experience breakthrough pain despite adequate chronic background pain treatment.3 Breakthrough pain comes on very quickly, lasts for about 30 minutes on average, and can be very intense.2 - 4 The ideal treatment should mimic the typical breakthrough pain episode and provide tight control of the pain, i.e. fast but short-acting pain relief.

The trial comparing intranasally with intravenously administered fentanyl showed that pain relief in all patients was 6 - 8 minutes after intranasal administration.1 The duration of pain relief provided by both routes was essentially the same.1 The bioavailability of the intranasal administered fentanyl was 89%.1

Dr Lona Christrup of the University of Copenhagen, Denmark, explained 'As a model for patients with cancer, we tested intranasal fentanyl to treat patients suffering pain after dental surgery.' Dr Christrup also stated that 'The intranasal fentanyl spray used in our study provided tight control of the pain meaning fast onset of action and relatively short duration of effect, making it a promising method for treating breakthrough cancer pain. This method of administration has the added advantage of being very easy to use, which is especially important for patients with cancer.'

These findings were discussed in the 'Challenges in treating breakthrough pain' satellite symposium, which examined the problems in treating and managing this debilitating condition. Breakthrough pain is a complex condition needing individualised patient management,5 and is a very widespread problem among patients with cancer.6 A drug with fast onset, short duration of action and ease of use was deemed to be the ideal treatment. Currently, oral morphine is the most frequently used treatment for breakthrough pain. However, oral morphine is far from ideal for patients with breakthrough cancer pain for two reasons. It takes about 30 minutes to have an effect, missing the majority of the breakthrough pain episode, and lasts for 4 - 6 hours, far longer than the breakthrough pain episode.

Commenting on the trial findings, Dr Andrew Davies, Consultant in Palliative Care, Royal Marsden Hospital said: 'The results of this trial are particularly interesting in terms of the potential use of intranasal fentanyl to relieve breakthrough pain in patients with cancer. This is a unique type of pain, and so needs a unique form of treatment. Our research has shown that most patients are prescribed strong oral opioid analgesics, despite the fact that these are not the best choice of treatment. Greater attention needs to be given to the problem of breakthrough pain, and healthcare professionals need to be made aware of the general principles of management, and particularly the pros and cons of different forms of strong opioid analgesics.'

For more information about breakthrough pain please visit the breakthrough pain resource http://www.breakthroughpain.eu where also full details of all presentations from the 'Challenges in treating breakthrough pain' satellite symposium can be found.

About Nycomed

Nycomed is an international pharmaceutical group that provides products for hospitals, specialists and general practitioners, as well as over-the-counter medicines in selected markets.

The company is active within a range of therapeutic areas, including cardiology, gastroenterology, osteoporosis, respiratory, pain and tissue management. New products are sourced both from own research and from external partners. Operating throughout Europe and in fast-growing markets such as Latin America, Russia/CIS and the Asia-Pacific region Nycomed has a presence in about 50 markets worldwide.

Privately owned, the combined group had non-audited estimated annual sales of approximately €3.4 billion and an EBITDA of €933.4 million (2006 results). In connection with the acquisition of the ALTANA Pharma AG, effective 1 January 2007, Nycomed is relocating its group headquarters from Roskilde (Denmark) to Zurich (Switzerland) in June 2007.

http://www.nycomed.com

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