Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Clinical and Translational Oncology
Published in: Clinical and Translational Oncology 5/2017

01-05-2017 | Research Article

Fentanyl pectin nasal spray for painful mucositis in head and neck cancers during intensity-modulated radiation therapy with or without chemotherapy

Authors: R. Mazzola, F. Ricchetti, A. Fiorentino, N. Giaj-Levra, S. Fersino, U. Tebano, S. Albanese, S. Gori, F. Alongi

Published in: Clinical and Translational Oncology | Issue 5/2017

Login to get access

Abstract

Purpose

The aim of the current analysis was to evaluate the effectiveness and tolerability of rapid onset opioid in a cohort of head and neck cancer (HNC) patients affected by painful mucositis influencing swallowing function during RT ± ChT with definitive or adjuvant intent.

Methods

A retrospective analysis was conduct on HNC patients during RT ± ChT that received fentanyl pectin na sal spray (FPNS) for incidental BTP due to painful mucositis 13 min before the main meals. The period of observation has been 90 days starting from the beginning of RT ± ChT.

Results

Forty HNC patients with incidental BTP due to painful mucositis treated with FPNS were analyzed. The mean NRS of untreated episodes of BTP was 5.73 ± 1.54 decreasing to 2.25 ± 2.45 with FPNS (median dose 100 mcg). During the pain treatment, the number of meals increased from 2.08 ± 0.35 to 2.868 ± 0.4 (p = 0.000), and the BMI remained stable (from 25.086 ± 3.292 to 25.034 ± 3.090; p = 0.448). The 94.9% of patients was satisfied or very satisfied for the rapidity of the effect, and 97.4% for the easiness and convenience in the use.

Conclusions

FPNS showed an acceptable safety activity profile in predictable BTP due to painful mucositis in HNC patients during RT ± ChT. FPNS was also effective in reducing the mucositis sequelae and allowing the completion of RT scheduled scheme. Moreover, patients declared satisfaction in terms of ease of use.
Literature
1.
Al-Ansari S, Zecha JA, Barasch A, de Lange J, Rozema FR, Raber-Durlacher JE. Oral mucositis induced by anticancer therapies. Curr Oral Health Rep. 2015;2(4):202–11.CrossRefPubMedPubMedCentral
2.
Elting LS, Keefe DM, Sonis ST, Garden AS, Spijkervet FK, Barasch A, et al. Patient-reported measurements of oral mucositis in head and neck cancer patients treated with radiotherapy with or without chemotherapy: demonstration of increased frequency, severity, resistance to palliation, and impact on quality of life. Cancer. 2008;113:2704–13.CrossRefPubMed
3.
Bossi P, Locati L, Bergamini C, Mirabile A, Granata R, Imbimbo M, et al. Fentanyl pectin nasal spray as treatment for incident predictable breakthrough pain (BTP) in oral mucositis induced by chemoradiotherapy in head and neck cancer. Oral Oncol. 2014;50(9):884–7.CrossRefPubMed
4.
Trotti A, Bellm LA, Epstein JB, Frame D, Fuchs HJ, Gwede CK, et al. Mucositis incidence, severity and associated outcomes in patients with head and neck cancer receiving radiotherapy with or without chemotherapy: a systematic literature review. Radiother Oncol. 2003;66:253–62.CrossRefPubMed
5.
Mazzola R, Ricchetti F, Fiorentino A, Di Paola G, Fersino S, Giaj Levra N, et al. Cachexia induces head and neck changes in locally advanced oropharyngeal carcinoma during definitive cisplatin and image-guided volumetric-modulated arc radiation therapy. Eur J Clin Nutr. 2016;70(6):738–42.CrossRefPubMed
6.
Koyfman SA, Adelstein DJ. Enteral feeding tubes in patients undergoing definitive chemoradiation therapy for head-and-neck cancer: a critical review. Int J Radiat Oncol Biol Phys. 2012;84(3):581–9.CrossRefPubMed
7.
Epstein JB, Wilkie DJ, Fischer DJ, Kim YO, Villines D. Neuropathic and nociceptive pain in head and neck cancer patients receiving radiation therapy. Head Neck Oncol. 2009;1:26.CrossRefPubMedPubMedCentral
8.
Schindler A, Denaro N, Russi EG, Pizzorni N, Bossi P, Merlotti A, et al. Dysphagia in head and neck cancer patients treated with radiotherapy and systemic therapies: literature review and consensus. Crit Rev Oncol Hematol. 2015;96(2):372–84.CrossRefPubMed
9.
Benoleil R, Epstein J, Eliav E, Jurevic R, Elad S. Orofacial pain in cancer. Part I: mechanisms. J Dent Res. 2007;86(6):491–505.CrossRef
10.
Bhatnagar S, Upadhyay S, Mishra S. Prevalence and characteristics of breakthrough pain in patients with head and neck cancer: a cross-sectional study. J Palliat Med. 2010;13:291–5.CrossRefPubMed
11.
Mirabile A, Airoldi M, Ripamonti C, Bolner A, Murphy B, Russi E, et al. Pain management in head and neck cancer patients undergoing chemo-radiotherapy: clinical practical recommendations. Crit Rev Oncol Hematol. 2016;99:100–6.CrossRefPubMed
12.
Portenoy RK, Payne D, Jacobsen P. Breakthrough pain: characteristics and impact in patients with cancer pain. Pain. 1999;81(1–2):129–34.CrossRefPubMed
13.
Bese NS, Hendry J, Jeremic B. Effects of prolongation of overall treatment time due to unplanned interruptions during radiotherapy of different tumor sites and practical methods for compensation. Int J Radiat Oncol Biol Phys. 2007;68:654–61.CrossRefPubMed
14.
Keefe DM, Schubert MM, Elting LS, Sonis ST, Epstein JB, Raber-Durlacher JE, et al. Updated clinical practice guidelines for the prevention and treatment of mucositis. Cancer. 2007;109:820–31.CrossRefPubMed
15.
Mercadante S, Marchetti P, Cuomo A, Mammucari M, Caraceni A, IOPS MS study Group. Breakthrough pain and its treatment: critical review and recommendations of IOPS (Italian Oncologic Pain Survey) expert group. Support Care Cancer. 2016;24(2):961–8.CrossRefPubMed
16.
Ripamonti CI, Santini D, Maranzano E, Berti M, Roila F, ESMO Guidelines Working Group. Management of cancer pain: ESMO Clinical Practice Guidelines. Ann Oncol 2012;23(Suppl 7):vii139–54.
17.
Caraceni A, Hanks G, Kaasa S, Bennett MI, Brunelli C, Cherny N, et al., European Association for Palliative Care EAPC. Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC. Lancet Oncol 2012; 13(2):e58–68.
18.
Fallon M, Reale C, Davies A, Lux AE, Kumar K, Stachowiak A, et al. Efficacy and safety of fentanyl pectin nasal spray compared with immediate-release morphine sulfate tablets in the treatment of breakthrough cancer pain: a multicenter, randomized, controlled, double-blind, double-dummy multiple-crossover study. J Support Oncol. 2011;9:224–31.CrossRefPubMed
19.
Davies A, Sitte T, Elsner F, Reale C, Espinosa J, Brooks D, et al. Consistency of efficacy, patient acceptability, and nasal tolerability of fentanyl pectin nasal spray compared with immediate-release morphine sulfate in breakthrough cancer pain. J Pain Symptom Manag. 2011;41(2):358–66.CrossRef
20.
Sonis ST, Elting LS, Keefe D, Peterson DE, Schubert M, Hauer-Jensen M, et al. Perspectives on cancer therapy-induced. Mucosal injury pathogenesis, measurement, epidemiology, and consequences for patients. Cancer Supplement 2004;100(9):1995–2025.
21.
Peterson DE, Bensadoun RJ, Roila F. Management of oral and gastrointestinal mucositis: ESMO clinical practice guidelines. Ann Oncol. 2011;22 (Supplement 6):vi78–vi84.
22.
23.
Popovtzer A, Cao Y, Feng FY, Eisbruch A. Anatomical changes in the pharyngeal constrictors after chemo-irradiation of head and neck cancer and their dose-effect relationships: MRI-based study. Radiother Oncol. 2009;93(3):510–5.CrossRefPubMedPubMedCentral
24.
Bhide AS, Gulliford S, Fowler J, Rosenfelder N, Newbold K, Harrington KJ, et al. Characteristics of response of oral and pharyngeal mucosa in patients receiving chemo-IMRT for head andneck cancer using hypofractionated accelerated radiotherapy. Radiother Oncol. 2010;97:86–91.CrossRefPubMed
25.
Mazzola R, Ricchetti F, Fiorentino A, Fersino S, Giaj Levra N, Naccarato S, et al. Dose-volume-related dysphagia after constrictor muscles definition in head and neck cancer intensity-modulated radiation treatment. Br J Radiol. 1044;2014(87):20140543.
26.
Mazzola R, Ricchetti F, Fersino S, Fiorentino A, Giaj Levra N, Di Paola G, et al. Predictors of mucositis in oropharyngeal and oral cavity cancer in patients treated with volumetric modulated radiation treatment: a dose-volume analysis. Head Neck. 2016;38(Suppl 1):E815–9.CrossRefPubMed
27.
Mazzola R, Ferrera G, Alongi F, Mannino M, Abbate B, Cucchiara T, et al. Organ sparing and clinical outcome with step-and-shoot IMRT for head and neck cancer: a mono-institutional experience. Radiol Med. 2015;120(8):753–8.CrossRefPubMed
28.
Ling IS, Larsson B. Individualized pharmacological treatment of oral mucositis pain in patients with head and neck cancer receiving radiotherapy. Support Care Cancer. 2011;19:1343–50.CrossRefPubMed
29.
Gayoso LO, Rijo GJ, Sánchez ÁR, De Celis RP, Albiach CF, Moreno AJC, et al. Radiotherapy induced breakthrough cancer pain: Is it possible to optimize its treatment? Revista de la Sociedad Espanola del Dolor 2015;22:4 (159–164).
Metadata
Title
Fentanyl pectin nasal spray for painful mucositis in head and neck cancers during intensity-modulated radiation therapy with or without chemotherapy
Authors
R. Mazzola
F. Ricchetti
A. Fiorentino
N. Giaj-Levra
S. Fersino
U. Tebano
S. Albanese
S. Gori
F. Alongi
Publication date
01-05-2017
Publisher
Springer International Publishing
Published in
Clinical and Translational Oncology / Issue 5/2017
Print ISSN: 1699-048X
Electronic ISSN: 1699-3055
DOI
https://doi.org/10.1007/s12094-016-1570-5

Other articles of this Issue 5/2017

Clinical and Translational Oncology 5/2017 Go to the issue

Research Article

Evaluation of diagnostic and prognostic significance of Ki-67 index in pulmonary carcinoid tumours

Research Article

HER2 mRNA transcript quantitation in breast cancer

Special Article

Gastrointestinal stromal tumors (GISTs): SEAP–SEOM consensus on pathologic and molecular diagnosis

Review Article

A consensus statement on the gender perspective in lung cancer

Research Article

Biological function and mechanism of miR-33a in prostate cancer survival and metastasis: via downregulating Engrailed-2

Research Article

Whole-body diffusion-weighted magnetic resonance imaging (WB-DW-MRI) vs choline-positron emission tomography-computed tomography (choline-PET/CT) for selecting treatments in recurrent prostate cancer
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits