The role of tapentadol as a strong opioid in cancer pain management: a systematic and critical review

Abstract

Aim: The aim of this review was to assess the role of tapentadol given at medium–high doses in opioid-tolerant patients for cancer pain management in place of step-3 analgesics.

Methods and results: A systematic literature search was performed out of which six studies and one secondary analysis provided data regarding tapentadol used as a step-3 analgesic for this review. Tapentadol, when used at ≥60 mg of oral morphine equivalents in opioid-tolerant patients with cancer pain, or passing from step-2 doses to ≥60 mg of oral morphine equivalents, was well tolerated and effective and could be considered as a flexible drug to be used for the management of moderate-to-severe cancer pain. The limited occurrence of gastrointestinal adverse effects may be a great advantage in the context of a disease like cancer, where multiple causes contribute to nausea, vomiting, or constipation; however, studies of tapentadol given at doses equivalent to step-3 level have some weaknesses, as data from prospective observational studies are poorly generalizable due to a small number of participants, controlled studies do not clearly show a superiority of tapentadol with respect to other opioids, and the sample size is often small.

Conclusions: More studies are necessary to confirm the role of tapentadol in cancer patients requiring strong opioids for their pain.

Keywords:

• Tapentadol
• cancer pain
• strong opioids
• palliative care

Transparency

Declaration of funding

The contents of the paper and the opinions expressed within are those of the author, and it was the decision of the author to submit the manuscript for publication.

Declaration of financial/other relationships

SM declares grant/research support and consultancy/advisory fees from Grünenthal. SB also declares speakers bureau from eva Pharmaceutical Industries Ltd, Molteni Farmaceutici, Kyowa Kirin Pharmaceutical Development, Inc., and Shionogi, Inc. Peer reviewers on this manuscript have received an honorarium from CMRO for their review work, but have no other relevant financial relationships to disclose.

Acknowledgments

Costs for editorial support have been sponsored by Grünenthal Italia S.r.l., who, however, has not taken part in any way in the study design or writing of the paper.

Notice of author disclosure

Costs for editorial support have been sponsored by Grünenthal Italia S.r.l., who however has not taken part in any way in the study design or writing of the paper.