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Abstract
Breakthrough cancer pain (BTcP) is a common condition in oncological patients. However, its management is still suboptimal. Improved knowledge of BTcP and its management in clinical practice may have immediate importance for all physicians involved in the supportive care of cancer patients. This review critically discusses the most important concepts for the correct diagnosis of BTcP and presents some intriguing cases of the management of this condition in clinical practice. Overall, the most appropriate therapeutic choice appears to be a rapid-onset opioid (ROO), and in particular, the nasal route of administration is the quickest and most convenient mode of administration for the management of BTcP, especially when the patient needs rapid resolution of pain. To this end, intranasal fentanyl spray may have a particular relevance in clinical practice. Future research should focus on accepted definitions of BTcP to investigate the optimal management of this highly heterogeneous pain condition. Therapeutic decision-making of patients, clinicians, and payers will likely be driven from results of well-designed clinical trials of ROOs.
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Acknowledgments
Editorial assistance for the preparation of this manuscript was conducted by Luca Giacomelli, PhD, and Aurora Mirabile, MD. This assistance was supported by internal funds.
Disclosure
Renato Vellucci received speaker/consultancy fees from Angelini, Grüenthal, Pfizer, Molteni, Norgine, Itafarmaco, TEVA and Sandoz. Rocco Domenico Mediati received speaker/consultancy fees from Angelini, Sigma-Tau, Pfizer, Molteni, Grüenthal, TEVA, and Mundipharma. Patrizia Romualdi received speaker/consultancy fees from Angelini, Molteni, Grüenthal and Sandoz. Massimo Mammucari received honoraria from Servier, Glaxo Wellcome, BioMedica, Pfizer, Merck Serono, Molteni, Serono Symposia International Foundation and Fondazione Lorenzini. The authors report no other conflicts of interest in this work.