New drugs for pain management in advanced cancer patients

ABSTRACT

Introduction: Advanced cancer patients represent a frail population, often requiring aggressive pain management, particularly in the late stage of disease, when untreated pain is one the most important causes of suffering.

Areas covered: In the last decade, a series of new analgesics have been introduced in the market to offer additional options amongst existent drugs. The characteristics of these drugs, their efficacy and tolerability are examined on the basis of existent studies.

Expert opinion: Although new analgesic preparations have been developed in recent years, no specific drug has provided a better analgesic performance in comparison with others. Some technologies have been developed to increase the safety or decrease the opioid-related adverse effects, with some molecules providing extra-opioid analgesia. However, existing studies did not present relevant advantages over traditional opioids. The new formulations developed to provide a rapid and non-invasive analgesia for breakthrough pain have really changed the approach to this phenomenon, characterized by a specific temporal pattern requiring a short onset, and duration of the analgesic effect. The availability of new drugs, indeed, may enlarge the possibilities of individualizing treatment, according to specific clinical needs and individual response.

KEYWORDS:

• Analgesics
• cancer pain
• end of life
• opioids

Article highlights

• New analgesic substances have been developed in the last decade and are characterized by different metabolic pathway, delivery systems, or receptor activities

• These drugs do not provide significant advantages over previous opioids, unless transmucosal fentanyl preparations which provided a better performance over oral morphine for breakthrough pain. Costs are of concerns.

• Globally, these drugs offer alternatives for cancer pain management in specific clinical conditions, underlying the need for individualization of the analgesic treatment.

• Many drugs failed to be approved for a commercial use and many others are in an experimental phase.

• More data are necessary to transfer encouraging experimental data in the clinical setting.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded.