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Sorrieul J, Robert J, Blanchet A, Gouju J, Bienfait F, Hamon SJ, Dupoiron D, Devys C. Physicochemical Stability Study of the Morphine-Bupivacaine-Ziconotide Association. Neuromodulation 2024:S1094-7159(23)01008-5. [PMID: 38300172 DOI: 10.1016/j.neurom.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/15/2023] [Accepted: 11/30/2023] [Indexed: 02/02/2024]
Abstract
OBJECTIVE The aim of this study was to investigate the physicochemical stability of morphine-bupivacaine-ziconotide mixtures used in intrathecal analgesia in polypropylene syringes and intrathecal pumps. MATERIALS AND METHODS The stability study method was conceived according to International Council for Harmonisation guidelines. For propylene syringes, six different mixtures of morphine-bupivacaine and ziconotide were assessed over seven days. Two storage temperatures were tested (5 °C ± 3 °C and 25 °C ± 2 °C). For implantable pumps, nine different mixtures were assessed over 60 days and stored at 37 °C. Assays were performed using ultrahigh-pressure liquid chromatography. Turbidity and pH also were measured throughout the study. RESULTS Results confirmed excellent physicochemical stability for morphine and bupivacaine in the study for all conditions investigated (pumps at 37 °C, polypropylene syringes at 5 °C ± 3 °C and 25 °C ± 2 °C). Concerning ziconotide, after seven days, our study showed that every 95% confidence interval calculated had lower bounds >90% for all mixtures stored in polypropylene syringes. In implantable pumps, a decrease of the concentration was observed in all the mixtures studied. Moreover, the appearance of a degradation product confirmed the ziconotide degradation. CONCLUSION All results are in favor with a physicochemical stable preparation for six mixture profiles when stored in polypropylene syringes at 5 °C ± 3 °C and 25 °C ± 2 °C. For mixtures stored in implantable pumps, the efficacy should decrease over time owing to the degradation of ziconotide. A trade-off between high morphine concentration and increased refill interval will need to be found by clinicians.
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Affiliation(s)
- Jeremy Sorrieul
- Pharmacy, Institut de Cancérologie de l'Ouest Paul Papin, Angers, France.
| | - Julien Robert
- Pharmacy, Institut de Cancérologie de l'Ouest Paul Papin, Angers, France
| | - Auriane Blanchet
- Pharmacy, Institut de Cancérologie de l'Ouest Paul Papin, Angers, France
| | - Julien Gouju
- Pharmacy, Institut de Cancérologie de l'Ouest Paul Papin, Angers, France
| | - Florent Bienfait
- Anesthesia and Pain Department, Institut de Cancérologie de l'Ouest Paul Papin, Angers, France
| | - Sabrina Jubier Hamon
- Anesthesia and Pain Department, Institut de Cancérologie de l'Ouest Paul Papin, Angers, France
| | - Denis Dupoiron
- Anesthesia and Pain Department, Institut de Cancérologie de l'Ouest Paul Papin, Angers, France
| | - Catherine Devys
- Pharmacy, Institut de Cancérologie de l'Ouest Paul Papin, Angers, France
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Dupoiron D, Deer T. Dura Fistula: A Rare Complication of Simultaneous Placement of Neurostimulation Leads and an Intrathecal Catheter. Neuromodulation 2023; 26:1883-1886. [PMID: 34077594 DOI: 10.1111/ner.13464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/12/2021] [Accepted: 05/04/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Denis Dupoiron
- Département Anesthésie-Douleur, Institut de Cancérologie de l'Ouest, site Paul Papin, Angers, France.
| | - Timothy Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA
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Dupoiron D, Autier L, Lebrec N, Seegers V, Folliard C, Patsouris A, Campone M, Augereau P. Intrathecal Catheter for Chemotherapy in Leptomeningeal Carcinomatosis From HER2-Negative Metastatic Breast Cancer. J Breast Cancer 2023; 26:572-581. [PMID: 37704384 PMCID: PMC10761759 DOI: 10.4048/jbc.2023.26.e40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/19/2023] [Accepted: 08/20/2023] [Indexed: 09/15/2023] Open
Abstract
PURPOSE Most oncological treatments for leptomeningeal metastasis (LM) do not cross the blood-brain barrier (BBB). One therapeutic option is intrathecal (IT) chemotherapy. Both the brain-implanted Omaya reservoir and lumbar puncture (LP) are classic routes for IT chemotherapy delivery. An intrathecal catheter (IC) connected to a subcutaneous port is a recently developed option for the management of chemotherapy infusions. It is essential to evaluate the efficacy and safety of chemotherapy infusion using such device. METHODS We conducted a retrospective monocentric study within Institut de cancerologie de l'Ouest at Angers, including all patients with advanced breast cancer (aBC) with LM implanted with an IT device for IT chemotherapy between January 2013 and May 2020. The primary endpoint was overall survival (OS) and secondary endpoints included surgical feasibility, patient safety, and progression-free survival (PFS). The catheter was inserted through an LP, the tip was positioned at the right level and connected to a subcutaneous port implanted under the skin of the anterior thoracic wall. IT chemotherapy is painless and easy for qualified nurses to administer on an outpatient basis. RESULTS Thirty women underwent the implantation. No failures occurred during the procedure. A total of 77% of patients reported no complications after implantation. Only three complications required surgical treatment. The median number of IT chemotherapy courses per patient was 8 (range, 2-27). The tolerance profile for iterative IT chemotherapy was manageable in ambulatory care. With a median follow-up of 76.5 months (95% confidence interval [CI], 11.6-not available), the median OS was 158 days (95% CI, 87-235), and the median PFS was 116 days (95% CI, 58-174). CONCLUSION Infusing chemotherapy using an implanted catheter is an efficient option for managing IT chemotherapy with a good tolerance profile. Patient-reported outcomes for the evaluation of IT chemotherapy toxicity are currently being developed.
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Affiliation(s)
- Denis Dupoiron
- Department of Anesthesiology and Pain Medicine, Institut de Cancerologie de l'Ouest, Angers, France.
| | - Lila Autier
- Department of Medical Oncology, Institut de Cancerologie de l'Ouest, Angers, France
| | - Nathalie Lebrec
- Department of Anesthesiology and Pain Medicine, Institut de Cancerologie de l'Ouest, Angers, France
| | - Valérie Seegers
- Department of Epidemiology and Biostatistics, Institut de Cancerologie de l'Ouest, Angers, France
| | - Caroline Folliard
- Department of Pharmacy, Institut de Cancerologie de l'Ouest, Angers, France
| | - Anne Patsouris
- Department of Medical Oncology, Institut de Cancerologie de l'Ouest, Angers, France
| | - Mario Campone
- Department of Medical Oncology, Institut de Cancerologie de l'Ouest, Angers, France
| | - Paule Augereau
- Department of Medical Oncology, Institut de Cancerologie de l'Ouest, Angers, France
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Dupoiron D, Bienfait F, Carvajal G, Seegers V, Douillard T, Jubier-Hamon S, Delorme T, Julienne A, Pluchon YM, Ribault N, Nader E, Lebrec N. Intrathecal cervical analgesia for cancer pain: a 12-year follow-up study in a comprehensive cancer center. Reg Anesth Pain Med 2023:rapm-2023-104961. [PMID: 37973378 DOI: 10.1136/rapm-2023-104961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Intrathecal analgesia plays a key role for patients suffering refractory cancer pain. Nevertheless, intrathecal drug delivery systems (IDDS), requiring a cervical catheter tip implantation, have been poorly described in medical literature. AIMS A monocentric retrospective follow-up study was designed to evaluate results of cervical IDDS for cancer pain. PATIENTS AND METHODS From January 2010 to December 2022, all intrathecal-treated patients were prescribed a combined intrathecal analgesics regimen through a catheter placed in the cervical vertebral canal. Post-implant assessment of pain was determined using a numeric rating scale (NRS). Patients were followed via day-hospital visits and telephone calls at least monthly. Pain scores were compared using the Wilcoxon's signed rank test. RESULTS Ninety-eight patients were included in this study; all received intrathecal treatments. Implanted patients suffered from severe pain (mean presurgical maximum numerical rating score 8.02±0.24 despite a mean 562.56±127.72 mg of oral morphine equivalent daily dose). Mean survival time after intrathecal treatment start was 208.48±67 days. Intrathecal drug delivery systems provided pain relief compared with initial pain score with a significant statistical difference after 1 week, 1 month, 2 and 3 months (p<0.01). A 50% reduction in initial pain level was achieved in 93% of cases during the first week of intrathecal implant. CONCLUSIONS Results suggest that long-term intrathecal treatment using a multidrug regimen for cancer-related pain through cervical intrathecal catheters was suitable and safe in our study population. We demonstrated a clinically and statistically significant pain reduction in patients using mainly a percutaneous lumbar approach.
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Affiliation(s)
- Denis Dupoiron
- Anesthesiology and Pain Department, Institut de Cancérologie de l'Ouest, Angers, France
| | - Florent Bienfait
- Anesthesiology and Pain Department, Institut de Cancérologie de l'Ouest, Angers, France
| | - Gabriel Carvajal
- Palliative Care, Costa Rica University, San Jose, San José, Costa Rica
| | - Valerie Seegers
- Epidemiology and Statistics Department, Institut de Cancerologie de l'Ouest Site Paul Papin, Angers, France
| | - Thomas Douillard
- Anesthesiology and Pain Department, Institut de Cancérologie de l'Ouest, Angers, France
| | - Sabrina Jubier-Hamon
- Anesthesiology and Pain Department, Institut de Cancérologie de l'Ouest, Angers, France
| | - Thierry Delorme
- Anesthesiology and Pain Department, Institut de Cancérologie de l'Ouest, Angers, France
| | - Arthur Julienne
- Anesthesiology and Pain Department, Institut de Cancérologie de l'Ouest, Angers, France
| | - Yves Marie Pluchon
- Pain Department, Centre Hospitalier Departmental La Roche-sur-Yon, La Roche-sur-Yon, Pays de la Loire, France
| | - Nicolas Ribault
- Neurosurgery Department, Centre Hospitalier Universitaire d'Angers, Angers, Pays de la Loire, France
| | - Edmond Nader
- Neurosurgery Department, Centre Hospitalier Universitaire d'Angers, Angers, Pays de la Loire, France
| | - Nathalie Lebrec
- Anesthesiology and Pain Department, Institut de Cancérologie de l'Ouest, Angers, France
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Bienfait F, Julienne A, Jubier-Hamon S, Seegers V, Delorme T, Jaoul V, Pluchon YM, Lebrec N, Dupoiron D. Correction: Bienfait et al. Evaluation of 8% Capsaicin Patches in Chemotherapy-Induced Peripheral Neuropathy: A Retrospective Study in a Comprehensive Cancer Center. Cancers 2023, 15, 349. Cancers (Basel) 2023; 15:3613. [PMID: 37509412 PMCID: PMC10377458 DOI: 10.3390/cancers15143613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 06/25/2023] [Indexed: 07/30/2023] Open
Abstract
In the original publication [...].
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Affiliation(s)
- Florent Bienfait
- Anaesthesiology and Pain Department, Institut de Cancérologie de l'Ouest, 49100 Angers, France
| | - Arthur Julienne
- Anaesthesiology and Pain Department, Institut de Cancérologie de l'Ouest, 49100 Angers, France
| | - Sabrina Jubier-Hamon
- Anaesthesiology and Pain Department, Institut de Cancérologie de l'Ouest, 49100 Angers, France
| | - Valerie Seegers
- Biometrics Department, Institut de Cancérologie de l'Ouest, 49100 Angers, France
| | - Thierry Delorme
- Anaesthesiology and Pain Department, Institut de Cancérologie de l'Ouest, 49100 Angers, France
| | - Virginie Jaoul
- Anaesthesiology and Pain Department, Institut de Cancérologie de l'Ouest, 49100 Angers, France
| | - Yves-Marie Pluchon
- Pain Management Consultation Center, Centre Hospitalier Départemental Vendée, 85925 La Roche-sur-Yon, France
| | - Nathalie Lebrec
- Anaesthesiology and Pain Department, Institut de Cancérologie de l'Ouest, 49100 Angers, France
| | - Denis Dupoiron
- Anaesthesiology and Pain Department, Institut de Cancérologie de l'Ouest, 49100 Angers, France
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Bienfait F, Julienne A, Jubier-Hamon S, Seegers V, Delorme T, Jaoul V, Pluchon YM, Lebrec N, Dupoiron D. Evaluation of 8% Capsaicin Patches in Chemotherapy-Induced Peripheral Neuropathy: A Retrospective Study in a Comprehensive Cancer Center. Cancers (Basel) 2023; 15:349. [PMID: 36672298 PMCID: PMC9856924 DOI: 10.3390/cancers15020349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023] Open
Abstract
Introduction: Chemotherapy-induced peripheral neuropathy (CIPN) is often painful and can arise during or after the end of oncological treatments. They are mostly induced by platinum salts, taxanes, and immunotherapies. Their incidence is estimated between 19 and 85%. They can require a chemotherapy dose reduction or early termination. The European Society for Medical Oncology (ESMO) recommends high-concentration capsaicin patch (HCCP) in second line for the treatment of painful CIPN. This treatment induces a significative pain relief but only shown by low-powered studies. The objective of this study was to evaluate efficacy and tolerability of HCCP applications in CIPN. Methods: This monocentric observational retrospective real-world-data study of the CERCAN cohort took place in the Western Cancer Institute's Anaesthesiology and Pain Department at Angers, France. Independent pain physicians completed the CGIC (Clinician Global Impression of Change) for each patient who benefited from HCCP applications for painful CIPN starting from 1 January 2014 to 22 December 2021, based on the collected data after every patch application. Results: A total of 57 patients (80.7% women) was treated with HCCP for painful CIPN, and 184 applications were realized, consisting of 296 sessions. CGIC found an important or complete pain relief for 61 applications (33.2%, corresponding to 43.9% patients). We found less efficacy for platinum-salts-induced CIPN compared to others (p = 0.0238). The efficacy was significatively higher for repeated applications when HCCP was used in second line compared to third line (p = 0.018). The efficacy of HCCP was significatively higher starting the third application (p = 0.0334). HCCPs were mainly responsible for local adverse events found in 66.6% patients (65.1% burning or painful sensation, 21.1% erythema). Conclusion: HCCP applications in painful CIPN induce an important pain relief with a global satisfying tolerability.
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Affiliation(s)
- Florent Bienfait
- Anaesthesiology and Pain Department, Institut de Cancérologie de l’Ouest, 49100 Angers, France; (A.J.); (S.J.-H.); (T.D.); (V.J.); (N.L.); (D.D.)
| | - Arthur Julienne
- Anaesthesiology and Pain Department, Institut de Cancérologie de l’Ouest, 49100 Angers, France; (A.J.); (S.J.-H.); (T.D.); (V.J.); (N.L.); (D.D.)
| | - Sabrina Jubier-Hamon
- Anaesthesiology and Pain Department, Institut de Cancérologie de l’Ouest, 49100 Angers, France; (A.J.); (S.J.-H.); (T.D.); (V.J.); (N.L.); (D.D.)
| | - Valerie Seegers
- Biometrics Department, Institut de Cancérologie de l’Ouest, 49100 Angers, France;
| | - Thierry Delorme
- Anaesthesiology and Pain Department, Institut de Cancérologie de l’Ouest, 49100 Angers, France; (A.J.); (S.J.-H.); (T.D.); (V.J.); (N.L.); (D.D.)
| | - Virginie Jaoul
- Anaesthesiology and Pain Department, Institut de Cancérologie de l’Ouest, 49100 Angers, France; (A.J.); (S.J.-H.); (T.D.); (V.J.); (N.L.); (D.D.)
| | - Yves-Marie Pluchon
- Pain Management Consultation Center, Centre Hospitalier Départemental Vendée, 85925 La Roche-sur-Yon, France;
| | - Nathalie Lebrec
- Anaesthesiology and Pain Department, Institut de Cancérologie de l’Ouest, 49100 Angers, France; (A.J.); (S.J.-H.); (T.D.); (V.J.); (N.L.); (D.D.)
| | - Denis Dupoiron
- Anaesthesiology and Pain Department, Institut de Cancérologie de l’Ouest, 49100 Angers, France; (A.J.); (S.J.-H.); (T.D.); (V.J.); (N.L.); (D.D.)
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Abrard S, Rineau E, Seegers V, Lebrec N, Sargentini C, Jeanneteau A, Longeau E, Caron S, Callahan JC, Chudeau N, Beloncle F, Lasocki S, Dupoiron D. Postoperative prophylactic intermittent noninvasive ventilation versus usual postoperative care for patients at high risk of pulmonary complications: a multicentre randomised trial. Br J Anaesth 2023; 130:e160-e168. [PMID: 34996593 DOI: 10.1016/j.bja.2021.11.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Pulmonary complications are an important cause of morbidity and mortality after surgery. We evaluated the clinical effectiveness of noninvasive ventilation (NIV) in preventing postoperative acute respiratory failure. METHODS This is an open, multicentre randomised trial that included patients at high risk of postoperative pulmonary complications after elective or semi-urgent surgery with an Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score ≥45. Patients were randomly assigned to intermittent prophylactic face-mask NIV for 6-8 h day-1 or usual postoperative care. The primary outcome was in-hospital acute respiratory failure within 7 days after surgery. Patients who underwent surgery and postoperative extubation were included in the modified intended-to-treat analysis. Results are presented as n (%) and odds ratios (ORs) with 95% confidence intervals. RESULTS Between November 2017 and October 2019, 266 patients were randomised and 253 included in the main analysis. Of these, 203 (80.2%) were male with a mean age of 68 (11) yr and an ARISCAT score of 53 (6); 237 subjects (93.7%) underwent cardiac or thoracic surgery. There were 125 patients allocated to prophylactic NIV and 128 to usual care. Unplanned treatment termination occurred in 58 subjects in the NIV group, which was linked to NIV discomfort for 36 subjects. There was no difference in the incidence of the primary outcome of postoperative acute respiratory failure between treatment groups (NIV: 30 of 125 subjects [24.0%] vs usual care: 35 of 128 subjects [27.3%]; OR 0.97 [0.90-1.04]; P=0.54). CONCLUSIONS Prophylactic NIV was difficult to implement after high-risk surgery because of low patient compliance. Prophylactic NIV did not prevent acute respiratory failure. CLINICAL TRIAL REGISTRATION NCT03629431 and EudraCT 2017-001011-36.
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Affiliation(s)
- Stanislas Abrard
- Department of Anesthesiology and Intensive Care, University Hospital of Angers, Angers, France; MITOVASC Institute, INSERM 1083, CNRS 6015, University of Angers, Angers, France; Department of Anesthesiology and Critical Care Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.
| | - Emmanuel Rineau
- Department of Anesthesiology and Intensive Care, University Hospital of Angers, Angers, France; MITOVASC Institute, INSERM 1083, CNRS 6015, University of Angers, Angers, France
| | - Valerie Seegers
- Department of Clinical Research, Integrated Center for Oncology Paul Papin, Angers, France
| | - Nathalie Lebrec
- Anesthesiology and Pain Medicine Department, Integrated Center for Oncology Paul Papin, Angers, France
| | - Cyril Sargentini
- Department of Anesthesiology and Intensive Care, University Hospital of Angers, Angers, France
| | - Audrey Jeanneteau
- Department of Anesthesiology and Intensive Care, University Hospital of Angers, Angers, France
| | - Emmanuelle Longeau
- Department of Anesthesiology and Intensive Care, University Hospital of Angers, Angers, France
| | - Sigrid Caron
- Department of Anesthesiology, Le Mans Hospital, Le Mans, France
| | | | - Nicolas Chudeau
- Department of Intensive Care, Le Mans Hospital, Le Mans, France
| | - François Beloncle
- Medical Intensive Care Department, University Hospital of Angers, Angers, France
| | - Sigismond Lasocki
- Department of Anesthesiology and Intensive Care, University Hospital of Angers, Angers, France
| | - Denis Dupoiron
- Anesthesiology and Pain Medicine Department, Integrated Center for Oncology Paul Papin, Angers, France
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Dupoiron D. Pain in cancer survivors: a challenge for the next decade. Ann Palliat Med 2023:apm-23-41. [PMID: 37038071 DOI: 10.21037/apm-23-41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- Denis Dupoiron
- Department of Anesthesiology, Integrated Center of Oncology, Angers, France
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Brogan SE, Dupoiron D, Papi B, Cheung AY, Calabrese A, Perruchoud C. Management of Cancer-Related Pain With Intrathecal Drug Delivery: A Systematic Review and MetaAnalysis of Clinical Studies. Neuromodulation 2022. [DOI: 10.1016/j.neurom.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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Dupoiron D, Brill S, Eeltink C, Barragán B, Bell D, Petersen G, Eerdekens M, Ryan D, Rakuša M. Diagnosis, management and impact on patients' lives of cancer-related neuropathic pain (CRNP): A European survey. Eur J Cancer Care (Engl) 2022; 31:e13728. [PMID: 36222099 PMCID: PMC9788326 DOI: 10.1111/ecc.13728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/21/2022] [Accepted: 09/27/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This study assessed the impact of cancer-related neuropathic pain (CRNP) on patients and the importance of the patient-healthcare professional (HCP) relationship in diagnosis and management. METHODS A quantitative online survey was conducted involving adult patients from 13 European countries who had been diagnosed with treatable cancer and experienced symptoms of peripheral neuropathy. RESULTS Of 24,733 screened respondents, 549 eligible persons met the inclusion criteria and completed the questionnaire. Among individuals still experiencing pain, 75% rated it as 'severe' or 'moderate'. In addition, 61% reported a negative impact on day-to-day activities, and 30% said they had stopped working as a result. A third of respondents had received no diagnosis of CRNP despite reporting painful symptoms to an HCP. HCPs spending enough time discussing pain and understanding the impact on patients' lives were each associated with an increased likelihood of a formal CRNP diagnosis. Compared with individuals currently in active cancer treatment, cancer survivors were less likely to have a diagnosis of CRNP or regular pain conversations with HCPs. CONCLUSION CRNP remains under-recognised despite its substantial impact on patients' lives. Clinical practice may be improved by strengthening patient-HCP relationships around pain discussions and increasing the focus on pain management among cancer survivors.
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Affiliation(s)
| | - Silviu Brill
- European Pain Federation EFICBrusselsBelgium,Pain InstituteTel Aviv Medical CenterTel AvivIsrael
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Lambe T, Duarte R, Eldabe R, Copley S, Kansal A, Black S, Dupoiron D, Eldabe S. Ziconotide for the Management of Cancer Pain: A Budget Impact Analysis. Neuromodulation 2022:S1094-7159(22)01255-7. [PMID: 36202713 DOI: 10.1016/j.neurom.2022.08.458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/17/2022] [Accepted: 08/23/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Recent recommendations on starting dose, smaller dose increments, and longer intervals between dose increase have the potential to increase the safety of ziconotide administration in addition to improving its value for money. Ziconotide is not routinely commissioned in England, with one of the concerns being whether it represents the best use of resources. The aim of this project is to conduct a budget impact analysis to estimate the costs or savings associated with the changes in ziconotide dosage in addition to its use in combination with morphine for the management of cancer pain. MATERIALS AND METHODS An open, Markov-like cohort decision analytic model was developed to estimate the budget impact of ziconotide in combination with morphine (ziconotide combination therapy) vs morphine monotherapy through intrathecal drug delivery (ITDD) for the management of cancer pain. The perspective adopted was that of the UK National Health Service, with a five-year time horizon. Sensitivity analyses were conducted to evaluate different scenarios. RESULTS Ziconotide combination therapy was more expensive than treatment with morphine monotherapy. The total costs of ziconotide combination therapy and morphine monotherapy for the first year were £395,748 and £136,628 respectively. The estimated five-year cumulative budget impact of treatment with ziconotide combination therapy for the five-year time horizon was £2,487,539, whereas that of morphine monotherapy was £913,804. The additional costs in any of the first five years are below the resource impact significance level of £1 million for medical technologies in England. CONCLUSIONS The results of this budget impact analysis suggest that although a combination of intrathecal ziconotide in combination with morphine is associated with higher costs to the health care system in England, the incremental costs are not significant. Routine commissioning of ziconotide alone or in combination with morphine would provide an alternative for a population with limited ITDD treatment options.
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Dupoiron D, Brill S, Eeeltink C, Bell D, Barragán B, Petersen G, Eerdekens M, Ryan D, Rakuša M. 1571P Cancer-related neuropathic pain (CRNP) in Europe: Impact of cancer stage on diagnosis and treatment of patients. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Brogan SE, Sindt JE, Odell DW, Gulati A, Dupoiron D. Controversies in intrathecal drug delivery for cancer pain. Reg Anesth Pain Med 2022; 48:319-325. [PMID: 35977779 DOI: 10.1136/rapm-2022-103770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/31/2022] [Indexed: 11/03/2022]
Abstract
Pain and suffering related to cancer are challenging issues that continue to deserve consideration for treatment optimization. Advances in analgesic management and control of the underlying cancer have improved symptom management, yet many patients still suffer from uncontrolled pain. Intrathecal drug delivery has an established role in the management of refractory cancer pain, but there are significant knowledge gaps in our understanding and application of this therapy. This review addresses several areas of controversy, including the importance of intrathecal catheter tip location, the necessity of an intrathecal trial and the role of intrathecal ziconotide and local anesthetics. In each area, the evidence is discussed, with an emphasis on presenting practical clinical guidance and highlighting deficiencies in our knowledge that are worthy of future investigation.
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Affiliation(s)
- Shane E Brogan
- Department of Anesthesiology, University of Utah Health, Salt Lake City, Utah, USA
| | - Jill E Sindt
- Department of Anesthesiology, University of Utah Health, Salt Lake City, Utah, USA
| | - Daniel W Odell
- Department of Anesthesiology, University of Utah Health, Salt Lake City, Utah, USA
| | - Amitabh Gulati
- Department of Anesthesiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Denis Dupoiron
- Department of Anesthesia and Pain Medicine, Institut de Cancerologie de l'Ouest Site Paul Papin, Angers, France
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Sorrieul J, Robert J, Vincent L, Andre M, Bourcier B, Bienfait F, Hamon SJ, Dupoiron D, Devys C. Stability of Morphine Sulfate-Clonidine and Sufentanil-Clonidine Mixtures. Neuromodulation 2022:S1094-7159(22)00769-3. [PMID: 36038481 DOI: 10.1016/j.neurom.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/27/2022] [Accepted: 07/12/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Spinal analgesia is recommended for intractable cancer pain. Morphine-clonidine and sufentanil-clonidine are often used in association in intrathecal drug delivery systems, injected by intraabdominal pumps. To refill these pumps and to limit patient transport, it may be necessary to ship the mixtures in polypropylene syringes to peripheral establishments located near patient homes. The purpose of this study is to determine the stability of morphine-clonidine and sufentanil-clonidine mixtures in polypropylene syringes to ensure the best and safest transport conditions and in implantable pumps for intrathecal use. MATERIALS AND METHODS The stability study method was conceived according to the International Council for Harmonization guidelines. For polypropylene syringes, four different mixtures of morphine-clonidine and sufentanil-clonidine were assessed over seven days. Two storage temperatures were tested (5 ± 3 °C and 25 ± 2 °C). For implantable pumps, two different mixtures of morphine-clonidine and sufentanil-clonidine were assessed over 28 days and stored at 37 °C. RESULTS For the morphine-clonidine mixtures in polypropylene syringes, all mixtures remained stable for five days in both storage conditions (5 ± 3 °C and 25 ± 2 °C) because of relative concentrations systematically positioned between 90% and 110% (95% CIs of the mean of three samples). The two mixtures in implantable pumps remained stable for 28 days. For the sufentanil-clonidine mixtures in polypropylene syringes, cold conservation kept all the preparations stable for seven days, whereas a quick degradation was observed after only two days for ambient storage conditions. This result is similar to that with an implantable pump, in which the concentration is <90% on day 7 for low concentration mixtures. No visual modification, no significant pH modification, and no changes in turbidity assays were observed in either study. CONCLUSION This study shows the stability of the morphine-clonidine mixtures in syringes stored at 5 °C for five days and in implantable pumps stored at 37 °C for 28 days. For the sufentanil-clonidine mixtures, the results show stability in syringes for seven days at 5 °C. Pump results show stability of seven days for low concentrations and 28 days for high concentrations.
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15
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Dupoiron D, Duarte R, Carvajal G, Aubrun F, Eldabe S. Rationale and Recent Advances in Targeted Drug Delivery for Cancer Pain: Is It Time to Change the Paradigm? Pain Physician 2022; 25:E414-E425. [PMID: 35652767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Cancer pain prevalence remains high with more than 60% of patients with advanced cancer experiencing cancer-related pain. The undertreatment of pain due to concerns of opioid dependence or diversion, as well as the potential effect of opioids on tumor neogenesis, add to the suffering among cancer populations. OBJECTIVES The aim of this narrative review was to assess evidence on the effectiveness, safety, cost-effectiveness, and advances of Intrathecal (IT) Drug Delivery Systems (IDDS) for the management of cancer pain. STUDY DESIGN The present review was performed by searching for articles indexed in PubMed, MEDLINE, SciELO, Google Scholar, and Scopus. METHODS Studies were included if they investigated patients with chronic cancer-related pain treated with IDDS and assessed experienced pain. We performed a narrative synthesis. RESULTS IDDS have demonstrated efficacy in relieving cancer pain even in the challenging treatment of head and neck cancer pain. IDDS is also associated with a large reduction in serum opioid concentrations limiting adverse effects. When combined with other analgesics commonly used in the spinal space, but not systemically, pain relief may be dramatically improved. Advances in IT drug diffusion, including mixtures created with pharmaceutical compounding, improve the safety and accuracy of this therapy. IDDS is cost-effective and safe yet remains underutilized in this patient population. LIMITATIONS Despite numerous clinical studies, only a small number of randomized trials have been conducted to evaluate the effectiveness of IDDS for cancer pain. CONCLUSIONS This article presents an overview of the current state of evidence on the effectiveness, safety, cost-effectiveness, and advances of IDDS for the management of cancer pain. Despite current evidence, IDDS remains underutilized for people with cancer pain. Potential areas to facilitate its use are discussed. A shift in the paradigm of cancer pain treatment should be considered given the undertreatment rate, lack of benefits, and considerable risks associated with oral opioid medication in many patients who suffer from chronic cancer pain.
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Affiliation(s)
- Denis Dupoiron
- Department of Anesthesiology and Pain Medicine, Institut de Cancerologie de l'Ouest, Angers, France
| | - Rui Duarte
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool - UK
| | - Gabriel Carvajal
- Centro Nacional de Control del Dolor y Cuidados Paliativos Interventional Pain Management Unit, San José, Costa Rica
| | - Frederic Aubrun
- Anesthesiology and Critical Care Department Centre Hospitalier Universitaire Lyon - France
| | - Sam Eldabe
- Department of Pain Medicine, The James Cook University Hospital, Middlesbrough - UK
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16
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Davies A, Cinieri S, Dupoiron D, España Fernandez S, Leclerc J, Montesarchio V, Mystakidou K, Serna J, Tack J. A Prospective, Real-World, Multinational Study of Naloxegol for Patients with Cancer Pain Diagnosed with Opioid-Induced Constipation-The NACASY Study. Cancers (Basel) 2022; 14:cancers14051128. [PMID: 35267436 PMCID: PMC8909554 DOI: 10.3390/cancers14051128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 02/08/2023] Open
Abstract
The Naloxegol Cancer Study (NACASY) was a multinational European study aimed to evaluate the 4-week safety and efficacy of naloxegol in a real-world setting in patients with cancer pain diagnosed with opioid-induced constipation. The primary safety endpoint was the incidence of adverse events leading to study discontinuation. We recruited 170 patients who received at least one dose of naloxegol (i.e., safety population). Out of 170 patients, 20 (11.8%, 95%CI 6.9-16.6) discontinued the study due to adverse events, and, of them, 12 (7.1%, 95%CI 3.2-10.9%) were study discontinuations due to naloxegol-related adverse events. From 76 patients subjects who had completed both 4 weeks of treatment and 28 days of the diary, 55 patients (72.4%, 95% CI 62.3-82.4%) were regarded as responders (i.e., showed ≥3 bowel-movements per week and an increase of ≥1 bowel-movement over baseline) to naloxegol treatment. The Patient Assessment of Constipation-Quality of Life Questionnaire total score and all its subscales improved from baseline to 4 weeks of follow up. Our findings support and provide new evidence about the beneficial effect of naloxegol in terms of improvement of constipation and quality-of-life in patients with cancer-related pain and opioid-induced constipation and show a safety profile consistent with previous pivotal and real-world studies.
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Affiliation(s)
- Andrew Davies
- Trinity College Dublin, University College Dublin, Our Lady’s Hospice Dublin’, D6W RY72 Dublin, Ireland
- Correspondence:
| | - Saverio Cinieri
- Medical Oncology, ASL Brindisi–P.O. “A. Perrino”, 72100 Brindisi, Italy;
| | - Denis Dupoiron
- Département d’Anesthésie–Douleur, Institut de Cancerologie de l’Ouest–Site Paul Papin, 49055 Angers, France;
| | - Sofia España Fernandez
- Medical Oncology Department, Institut Català d’Oncologia-Badalona, 08916 Barcelona, Spain;
| | | | - Vincenzo Montesarchio
- UOC Ongologia, A.O.R.N. dei Colli–Monaldi–Coutgno–C.T.O. Hospitals, 80131 Napoli, Italy;
| | - Kyriaki Mystakidou
- Palliative Care Unit “Jenny Karezi”, School of Medicine, University of Athens, 11526 Athens, Greece;
| | - Judith Serna
- Hospital Universitari Vall D’hebron, 08035 Barcelona, Spain;
| | - Jan Tack
- University Hospital Gasthuisberg, 3000 Leuven, Belgium;
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Dupoiron D, Jubier-Hamon S, Seegers V, Bienfait F, Pluchon YM, Lebrec N, Jaoul V, Delorme T. Peripheral Neuropathic Pain Following Breast Cancer: Effectiveness and Tolerability of High-Concentration Capsaicin Patch. J Pain Res 2022; 15:241-255. [PMID: 35136354 PMCID: PMC8817739 DOI: 10.2147/jpr.s341378] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/03/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Data supporting the use of high-concentration capsaicin patches (HCCPs) in breast cancer (BC) patients and BC survivors (BCSs) with peripheral neuropathic pain (PNP) are limited. This observational study evaluated the effectiveness and safety of HCCP applications in BCSs/BC patients with PNP. Patients and Methods Data from all patients treated with HCCP in the pain department of a French comprehensive cancer centre were collected from 01-Jan-2014 to 14-Oct-2020. Independent pain specialists completed the Clinical Global Impression of Change (CGIC) for each included patient based on data extracted from patient’s electronic medical record compiled by the treating pain specialist after each HCCP application. Results Patients (N=279; mean age: 59.2 years; previous history of PNP medication: 54.5%) received on average 4.1 repeated HCCP applications (1141 HCCP applications); 68.8% received HCCP as an add-on to systemic therapy and 27.9% as first-line therapy. PNP was most frequently caused by surgery (62.4%) followed by chemotherapy (11.8%) and radiotherapy (6.5%). A complete or important analgesic effect was reported at least once by 82.3% of patients. A 6.0% reported no effect at all. For post-surgical PNP existing for <12 months and >10 years an important or complete effect was observed for 70.7% and 56.0% of applications. For chemotherapy- or radiotherapy-induced PNP, this important or complete effect was observed for 52.7% and 52.3% of applications, respectively. HCCP application was associated with site reactions in 54.4% of patients (mainly burning sensation or pain, 45.9%, or erythema, 30.8%) and high blood pressure in 7.2%. Conclusion This real-world chart review provides important effectiveness and safety information to clinicians when considering topical options to treat PNP in BCSs/BC patients.
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Affiliation(s)
- Denis Dupoiron
- Département Anesthésie – Douleur, Institut de Cancérologie de l’Ouest, Angers, France
- Correspondence: Denis Dupoiron, Département Anesthésie – Douleur, Institut de Cancérologie de l’Ouest, Angers, France, Tel +33 2 41 35 28 73, Email
| | - Sabrina Jubier-Hamon
- Département Anesthésie – Douleur, Institut de Cancérologie de l’Ouest, Angers, France
| | - Valerie Seegers
- Département de biométrie, Institut de Cancérologie de l’Ouest, Angers, France
| | - Florent Bienfait
- Département Anesthésie – Douleur, Institut de Cancérologie de l’Ouest, Angers, France
| | - Yves Marie Pluchon
- Centre d’étude et de traitement de la douleur (CETD), Centre hospitalier départemental Vendée, La Roche-sur-Yon, France
| | - Nathalie Lebrec
- Département Anesthésie – Douleur, Institut de Cancérologie de l’Ouest, Angers, France
| | - Virginie Jaoul
- Département Anesthésie – Douleur, Institut de Cancérologie de l’Ouest, Angers, France
| | - Thierry Delorme
- Département Anesthésie – Douleur, Institut de Cancérologie de l’Ouest, Angers, France
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Perruchoud C, Dupoiron D, Papi B, Calabrese A, Brogan SE. Management of Cancer-Related Pain With Intrathecal Drug Delivery: A Systematic Review and Meta-Analysis of Clinical Studies. Neuromodulation 2022:S1094-7159(21)06969-5. [PMID: 35088743 DOI: 10.1016/j.neurom.2021.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Despite increased attention paid to assessment and management, pain continues to be a prevalent and undertreated symptom in patients with cancer. Intrathecal drug delivery (IDD) is a therapeutic option that allows targeted delivery of analgesics to the intrathecal space. OBJECTIVE The aim of this review was to examine the efficacy of managing cancer-related pain with IDD. Secondary objectives included the effects of IDD on systemic opioid use and infection rates. EVIDENCE REVIEW A systematic search of the literature published between 1990 and 2019 was performed to identify studies evaluating the efficacy and/or safety of IDD with external or implanted pumps in patients with cancer-related pain. Data were extracted and meta-analyses performed to determine the mean changes in pain levels at short-, mid-, and long-term intervals; changes in opioid (oral morphine equivalent [OME]) daily dose; and infection rates. Changes were assessed compared with baseline. FINDINGS Pain levels were decreased from baseline: On a 0 to 10 scale, mean differences were -4.34 (95% CI [-4.93 to -3.75], p < 0.001) at 4 to 5 weeks; -4.34 (95% CI [-5.07 to -3.62], p < 0.001) at 6 to 12 weeks; and -3.32 (95% CI [-4.60 to -2.04], p < 0.001) at >6 months. Weighted mean OME consumption was reduced by 308.24 (SE = 22.72) mg/d. Weighted mean infection rates were ∼3% for external and implanted pumps. CONCLUSIONS Meta-analyses show a statistically significant and sustained decrease in cancer pain with IDD, compared with baseline. Systemic opioid consumption was reduced on average by >50% after IDD. Infection rates were comparable with other indications.
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19
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Rakusa M, Dupoiron D, Eeeltink C, Riel F, Barragán B, Bell D, Petersen G, Schofield S, Ryan D, Brill S. Cancer-related neuropathic pain (CRNP) in Europe: What are the gaps in diagnosis and treatment from patients' perspective? J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.118640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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20
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Dupoiron D. Intrathecal Analgesia in Cancer Pain. Cancer Treat Res 2021; 182:225-237. [PMID: 34542885 DOI: 10.1007/978-3-030-81526-4_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The number of new cancer cases has been increasing globally over the last several decades.
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Affiliation(s)
- Denis Dupoiron
- Anesthesia and Pain Department, Institut de Cancérologie de L'Ouest, Rue Boquel, 49055, Angers, France.
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21
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Dupoiron D. Cancer Pain Management-A European Perspective. Cancer Treat Res 2021; 182:39-55. [PMID: 34542875 DOI: 10.1007/978-3-030-81526-4_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Cancer pain management is a major challenge in both Europe and the United States. Recent studies show that the incidence of cancer pain remains high and even increases at an advanced stage of the disease.
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Affiliation(s)
- Denis Dupoiron
- Anesthesia and Pain Department, Institut de Cancérologie de l'Ouest, Rue Boquel, 49055, Angers, France.
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22
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Autier L, Augereau P, Lebrec N, Seegers V, Soulié P, Patsouris A, Campone M, Dupoiron D. 322P Intrathecal catheter for chemotherapy in leptomeningeal metastatic breast cancer. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Bienfait F, Jubier-Hamon S, Seegers V, Pluchon YM, Lebrec N, Jaoul V, Boré F, Delorme T, Robert J, Bellanger M, Sorrieul J, Dupoiron D. First Evaluation Switching From Ropivacaine to Highly Concentrated Bupivacaine in Intrathecal Mixtures for Cancer Pain. Neuromodulation 2021; 24:1215-1222. [PMID: 34181790 DOI: 10.1111/ner.13469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/23/2021] [Accepted: 05/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Intrathecal drug delivery is widely used for intractable cancer pain treatment. A combination of drugs with morphine and bupivacaine is recommended in first line therapy. In France, we use ropivacaine 10 mg/mL instead of bupivacaine 5 mg/mL, the only concentration available. Bupivacaine 40 mg/mL has been available in France only since July 2020 under temporary authorization of use. OBJECTIVES The main objective of the study was to evaluate the safety, efficacy by pain assessment, to analyze drug dosage changes, to report adverse events (AEs) and conversion ratios switching from ropivacaine to bupivacaine. Secondary objective was to evaluate costs differences. MATERIALS AND METHODS We conducted this retrospective follow-up monocentric study within the Institut de Cancérologie de l'Ouest (ICO) Pain Department in Angers, France. We included 14 patients aged 18 years and above, implanted with an Intrathecal Drug Delivery Systems (IDDS) for cancer pain treatment and followed up at ICO from July 2020 to February 2021 after switching from ropivacaine to bupivacaine. We used a continuous infusion mode and Bolus could be added through Personal Therapy Manager (PTM). RESULTS The median conversion ratio between ropivacaine and bupivacaine was 0.68 (0.65; 0.69) and resulted in no significant change in numeric rating scale evaluation (p = 0.10). We observed moderate and rapidly reversible AEs such as clinical hypotension (29%) and motor block after bolus (21%). The estimated median hospital cost per day was significantly lower (p = 0.05) for the bupivacaine refills than for the last ropivacaine pump refill, decreasing from US$ 61.7 (49.6; 70.5) to US$ 50.4 (45.9; 60.4). The median reimbursement per day from the National Health Insurance (NHI) was three times lower for bupivacaine pump refill when compared to the last ropivacaine pump refill (p < 0.01), decreasing from US$ 179.10 (156.79; 182.91) to US$ 64.59 (59.85; 71.89). CONCLUSION Switching from ropivacaine to bupivacaine in IDDS appears more efficacious while remaining just as secure, and at lower cost.
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Affiliation(s)
- Florent Bienfait
- Department of Anesthesiology and Pain Medicine, Institut de Cancerologie de l'Ouest, Angers, France
| | - Sabrina Jubier-Hamon
- Department of Anesthesiology and Pain Medicine, Institut de Cancerologie de l'Ouest, Angers, France
| | - Valérie Seegers
- Department of Epidemiology and Biostatistics, Institut de Cancerologie De l'Ouest, Angers, France
| | | | - Nathalie Lebrec
- Department of Anesthesiology and Pain Medicine, Institut de Cancerologie de l'Ouest, Angers, France
| | - Virginie Jaoul
- Department of Anesthesiology and Pain Medicine, Institut de Cancerologie de l'Ouest, Angers, France
| | - François Boré
- Department of Anesthesiology and Pain Medicine, Institut de Cancerologie de l'Ouest, Angers, France
| | - Thierry Delorme
- Department of Anesthesiology and Pain Medicine, Institut de Cancerologie de l'Ouest, Angers, France
| | - Julien Robert
- Pharmacy, Institut de Cancerologie de l'Ouest, Angers, France
| | - Martine Bellanger
- Department of Human and Social Sciences, Institut de Cancerologie de l'Ouest, Nantes, France.,EHESP School of Public Health, Paris, France
| | - Jérémy Sorrieul
- Pharmacy, Institut de Cancerologie de l'Ouest, Angers, France
| | - Denis Dupoiron
- Department of Anesthesiology and Pain Medicine, Institut de Cancerologie de l'Ouest, Angers, France
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Dupoiron D, Narang S, Seegers V, Lebrec N, Boré F, Jaoul V, Pechard M, Hamon SJ, Delorme T, Douillard T. Preventing Post Dural Puncture Headache after Intrathecal Drug Delivery System Implantation Through Preventive Fibrin Glue Application: A Retrospective Study. Pain Physician 2021; 24:E211-E220. [PMID: 33740358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Cerebrospinal fluid (CSF) leakage resulting in post dural puncture headache (PDPH) is a frequent adverse effect observed after intrathecal drug delivery system (IDDS) implantation. CSF leakage symptoms negatively affect patient quality of life and can result in additional complications. Fibrin glue was used to treat CSF leakage syndrome. We developed a procedure to reduce the incidence of PDPH by preventing CSF leakage with the use of fibrin glue during surgery. OBJECTIVES The main outcome criterion for this study was the incidence of PDPH syndrome after IDDS implantation with or without preventive fibrin glue application during the procedure. STUDY DESIGN We designed a monocentric retrospective cohort study to compare the incidence of PDPH due to CSF leakage syndrome after lumbar puncture in patients with an implanted intrathecal pump, with or without preventive fibrin glue application during the procedure. SETTING The study was held in the Anesthesiology and Pain department of the Integrative Cancer Institute (ICO), Angers - France. METHODS The study compared 2 patient cohorts over 2 successive periods. Fibrin glue was injected into the introducer needle puncture pathway after placement of the catheter immediately following needle removal. RESULTS The no-glue group included 107 patients, whereas the glue group included 92 patients.Two application failures were observed (2.04%). Fibrin glue application results in a significant decrease in PDPH incidence, from 32.7% in the no-glue group to 10.92 % (P < 0.001) in the glue group. In regard to severity, in the no-glue group, 37.1% of PDPH syndromes were mild, 34.3% were moderate, and 28.6% were severe. In the fibrin glue group, 80% of PDPH syndromes were mild, and 20% were moderate. No severe PDPHs were reported after fibrin glue application. Duration of symptoms was also statistically shorter in the fibrin glue group (maximum of 3 days vs. 15 days in the no-glue group). In a univariate analysis, preventive fibrin glue application and age are significant to prevent PDPH. In multivariate analysis, only fibrin glue application was statistically significant (odds ratio, 0.26; P = 0.0008). No adverse effects linked to fibrin glue were observed. LIMITATIONS The main limitation of this study is its retrospective nature. In addition, this study is from a single center with a potential selection bias and a center effect. CONCLUSIONS The novel use of fibrin glue is promising in terms of its effect on PDPH and its safety profile. Its moderate cost and reproducibility make it an affordable and efficient technique.
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Affiliation(s)
- Denis Dupoiron
- Anesthesia and Pain Department, Institut de cancérologie de l'ouest - Paul Papin, Angers, France
| | - Sanjeet Narang
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA
| | - Valerie Seegers
- Department of Epidemiology and Biostatistics, Institut de Cancerologie De l'Ouest, Angers, France
| | - Nathalie Lebrec
- Department of Anesthesiology and Pain Medicine, Institut de Cancerologie de l'Ouest, Angers, France
| | - François Boré
- Department of Anesthesiology and Pain Medicine, Institut de Cancerologie de l'Ouest, Angers, France
| | - Virginie Jaoul
- Department of Anesthesiology and Pain Medicine, Institut de Cancerologie de l'Ouest, Angers, France
| | - Marie Pechard
- INSERM U987, Department of Anesthesiology and Pain Medicine, Institut Curie, Paris, France
| | - Sabrina Jubier Hamon
- Department of Anesthesiology and Pain Medicine, Institut de Cancerologie de l'Ouest, Angers, France
| | - Thierry Delorme
- Department of Anesthesiology and Pain Medicine, Institut de Cancerologie de l'Ouest, Angers, France
| | - Thomas Douillard
- Department of Anesthesiology and Pain Medicine, Institut de Cancerologie de l'Ouest, Angers, France
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25
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Matis G, De Negri P, Dupoiron D, Likar R, Zuidema X, Rasche D. Intrathecal pain management with ziconotide: Time for consensus? Brain Behav 2021; 11 Suppl 1:e02055. [PMID: 33690987 PMCID: PMC7943290 DOI: 10.1002/brb3.2055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/02/2020] [Accepted: 01/17/2021] [Indexed: 12/25/2022] Open
Abstract
This article summarizes recommendations made by six pain specialists who discussed the rationale for ziconotide intrathecal analgesia (ITA) and the requirement for evidence-based guidance on its use, from a European perspective. Riemser Pharma GmbH (Greifswald, Germany), which holds the European marketing authorization for ziconotide, hosted the meeting. The group agreed that ITA is under-used in Europe, adding that ziconotide ITA has potential to be a first-line alternative to morphine; both are already first-line options in the USA. Ziconotide ITA (initiated using a low-dose, slow-titration approach) is suitable for many patients with noncancer- or cancer-related chronic refractory pain and no history of psychosis. Adopting ziconotide as first-line ITA could reduce opioid usage in these patient populations. The group advocated a risk-reduction strategy for all candidate patients, including compulsory prescreening for neuropsychosis, and requested US-European alignment of the licensed starting dose for ziconotide: the low-and-slow approach practiced in the USA has a better tolerability profile than the fixed high starting dose licensed in Europe. Of note, an update to the European Summary of Product Characteristics is anticipated in early 2021. The group acknowledged that the Polyanalgesic Consensus Conference (PACC) treatment algorithms for ziconotide ITA provide useful guidance, but recommendations tailored specifically for European settings are required. Before a consensus process can formally begin, the group called for additional European prospective studies to investigate ziconotide in low-and-slow dosing strategies, in different patient settings. Such data would enable European guidance to have the most appropriate evidence at its core.
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Affiliation(s)
- Georgios Matis
- Department of Stereotactic and Functional NeurosurgeryFaculty of Medicine and University Hospital CologneUniversity of CologneCologneGermany
| | - Pasquale De Negri
- Department of Anaesthesia, Intensive Care and Pain MedicineSan Giuliano HospitalGiugliano, NaplesItaly
| | - Denis Dupoiron
- Anesthesiology and Pain DepartmentInstitut de Cancérologie de l’OuestICO Paul PapinAngersFrance
| | - Rudolf Likar
- Department of Anaesthesiology and Intensive CareKlagenfurt ClinicKlagenfurtAustria
| | - Xander Zuidema
- Department of Anaesthesiology and Pain MedicineDiakonessenhuis Utrecht/ZeistZeistThe Netherlands
| | - Dirk Rasche
- Functional Neurosurgery and Neurosurgical Pain TherapyUniversity Hospital Schleswig‐HolsteinLübeckGermany
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Sorrieul J, Robert J, Dupoiron D, Devys C. Stability Study of Admixtures Combining Ziconotide With Morphine or Sufentanil in Polypropylene Syringes. Neuromodulation 2020; 24:1145-1156. [PMID: 33095956 DOI: 10.1111/ner.13289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The association of morphine ziconotide or sufentanil ziconotide was used to manage cancer pain. Moving these patients is sometimes difficult. In order to transport these syringes for pump refilling, it could be interesting to demonstrate the stability of the mixture and so to be able to ensure the best transport conditions of syringes. MATERIALS AND METHODS A stability indicating UPLC-DAD method was developed and validated according to the ICH guidelines. Fur mixtures of each association have been stored in 5 ± 3°C and 25 ± 2°C and were evaluated for seven days and compared to the initial observed concentrations. RESULTS The stability of these associations was demonstrated at 5°C for seven days thanks to relative concentrations (95% confidence intervals of the mean of three samples) systematically positioned between 95% and 105%. No degradation product was observed during the stability study. CONCLUSION This study shows the stability of these association morphine ziconotide or sufentanil ziconotide at 5°C for seven days in polypropylen syringes. This result will allow the transport of the preparation under optimal conditions. Advance preparations for intrathecal pump refills could also be feasible.
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Affiliation(s)
- Jérémy Sorrieul
- Institut de Cancérologie de l'Ouest Paul Papin - Pharmacy, Angers, France
| | - Julien Robert
- Institut de Cancérologie de l'Ouest Paul Papin - Pharmacy, Angers, France
| | - Denis Dupoiron
- Institut de Cancérologie de l'Ouest Paul Papin - Anesthesia and Pain Department, Angers, France
| | - Catherine Devys
- Institut de Cancérologie de l'Ouest Paul Papin - Pharmacy, Angers, France
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Robert J, Sorrieul J, Andrieu A, Mounsef F, Dupoiron D, Devys C. Study of Physicochemical Stability of Ziconotide in Medication Cassette Reservoir. Neuromodulation 2020; 23:1034-1041. [DOI: 10.1111/ner.13218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 04/30/2020] [Accepted: 05/10/2020] [Indexed: 11/27/2022]
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Dupoiron D, Montesarchio V, Lecrerc J, Cinieri S, España S, Fernandez A, Sanz J, Tack J, Davies A. 1866P Preliminary quality of life and safety results of naloxegol for patients with cancer pain diagnosed with opioid induced constipation. NACASY study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Dupoiron D. Targeted Drug Delivery (Intrathecal and Intracranial) for Treatment of Facial Pain. Prog Neurol Surg 2020; 35:181-193. [PMID: 32814331 DOI: 10.1159/000509623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 06/21/2020] [Indexed: 11/19/2022]
Abstract
Despite the high incidence of facial pain, targeted drug delivery remains a rarely used technique for treatment of otherwise refractory pain. Two distinct paths have been described. The intraventricular route allows direct access to intracerebral opioid receptors. The more recently introduced upper cervical or cisternal intrathecal route, is based on the same theories as classical intrathecal route. Intraventricular route was first described by A.K. Ommaya; its use remains limited, mostly with morphine, despite a high clinical efficiency, probably because of the invasive nature of the procedure and the need for daily direct injections. The ability to connect the catheter to an implantable pump may help to facilitate the acceptance of this approach. The also rarely used high cervical intrathecal or cisternal route is very efficient, because facial pain signals are transmitted mainly via the trigeminal nerve roots and synapse on the second-order neurons in an area that extends from the lower brainstem to the C1 and C2 levels of the spinal cord. The risks of cervical puncture may explain the rarity of its use. However, new devices allowing a simpler lumbar approach and the ongoing opioid crisis are the factors that may facilitate the wider use of this effective technique for the treatment of facial pain.
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Affiliation(s)
- Denis Dupoiron
- Anesthesiology and Pain Department, Institut de Cancerologie de l'Ouest - Paul Papin, Angers, France,
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Reynaert ML, Dupoiron D, Yeramian E, Marsollier L, Brodin P. Could Mycolactone Inspire New Potent Analgesics? Perspectives and Pitfalls. Toxins (Basel) 2019; 11:toxins11090516. [PMID: 31487908 PMCID: PMC6783859 DOI: 10.3390/toxins11090516] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/26/2019] [Accepted: 09/03/2019] [Indexed: 12/20/2022] Open
Abstract
Pain currently represents the most common symptom for which medical attention is sought by patients. The available treatments have limited effectiveness and significant side-effects. In addition, most often, the duration of analgesia is short. Today, the handling of pain remains a major challenge. One promising alternative for the discovery of novel potent analgesics is to take inspiration from Mother Nature; in this context, the detailed investigation of the intriguing analgesia implemented in Buruli ulcer, an infectious disease caused by the bacterium Mycobacterium ulcerans and characterized by painless ulcerative lesions, seems particularly promising. More precisely, in this disease, the painless skin ulcers are caused by mycolactone, a polyketide lactone exotoxin. In fact, mycolactone exerts a wide range of effects on the host, besides being responsible for analgesia, as it has been shown notably to modulate the immune response or to provoke apoptosis. Several cellular mechanisms and different targets have been proposed to account for the analgesic effect of the toxin, such as nerve degeneration, the inhibition of inflammatory mediators and the activation of angiotensin II receptor 2. In this review, we discuss the current knowledge in the field, highlighting possible controversies. We first discuss the different pain-mimicking experimental models that were used to study the effect of mycolactone. We then detail the different variants of mycolactone that were used in such models. Overall, based on the results and the discussions, we conclude that the development of mycolactone-derived molecules can represent very promising perspectives for new analgesic drugs, which could be effective for specific pain indications.
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Affiliation(s)
- Marie-Line Reynaert
- France Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019-UMR8204-CIIL-Center for Infection and Immunity of Lille, F-59000 Lille, France
| | - Denis Dupoiron
- Institut de Cancérologie de l'Ouest Paul Papin, 15 rue André Boquel-49055 Angers, France
| | - Edouard Yeramian
- Unité de Microbiologie Structurale, Institut Pasteur, CNRS, Univ. Paris, F-75015 Paris, France
| | - Laurent Marsollier
- Equipe ATIP AVENIR, CRCINA, INSERM, Univ. Nantes, Univ. Angers, 4 rue Larrey, F-49933 Angers, France.
| | - Priscille Brodin
- France Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019-UMR8204-CIIL-Center for Infection and Immunity of Lille, F-59000 Lille, France.
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Dupoiron D, Leblanc D, Demelliez-Merceron S, Bore F, Seegers V, Dubois PY, Pechard M, Robard S, Delorme T, Jubier-Hamon S, Carvajal G, Lebrec N. Optimizing Initial Intrathecal Drug Ratio for Refractory Cancer-Related Pain for Early Pain Relief. A Retrospective Monocentric Study. Pain Medicine 2019; 20:2033-2042. [DOI: 10.1093/pm/pnz096] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Abstract
Objective
Intrathecal (IT) drug delivery has shown its efficiency in treating refractory cancer pain, but switching opioids from the systemic to the intrathecal route is a challenging phase. Moreover, associations are widely used and recommended. Few data deal with the initial dosage of each drug. Analyzing conversion factors and initial dosages used in intrathecal therapy seems essential to decreasing the length of titration and to delivering quick pain relief to patients.
Methods
We retrospectively analyzed data from consecutive adult patients implanted with an intrathecal device for cancer pain and treated at the Institut de Cancérologie de l’Ouest, in Angers, France, for four years. The main goal was to identify factors associated with early pain relief after intrathecal drug delivery system (IDDS) implantation.
Results
Of the 220 IDDS-treated patients, 70 (32%) experienced early pain relief (EaPR) and 150 (68%) delayed pain relief (DePR). Performance Status stage and initial IT ropivacaine:IT morphine ratio were the variables independently associated with EaPR. The best IT ropivacaine:IT morphine ratio to predict EaPR was 5:1, with a 73% (95% confidence interval [CI] = 64.8% to 79.6%) sensitivity and a 67.1% (95% CI = 54.9% to 77.9%) specificity. EaPR subjects experienced better pain relief (–84% vs –60% from baseline pain score, P < 0.0001), shorter length of hospitalization (7 vs 10 days, P < 0.0001), and longer survival (155 vs 82 days, P = 0.004).
Conclusions
Local anesthetic:morphine ratio should be considered when starting IDDS treatment. EaPR during the IT analgesia titration phase was associated with better pain relief and outcomes in patients with refractory cancer-related pain.
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Affiliation(s)
- Denis Dupoiron
- Anesthesiology and Pain Department, Institut de Cancerologie de l’Ouest Paul Papin, Angers, France
| | - Damien Leblanc
- Anesthesiology and Pain Department, Institut de Cancerologie de l’Ouest Paul Papin, Angers, France
| | | | - Francois Bore
- Anesthesiology and Pain Department, Institut de Cancerologie de l’Ouest Paul Papin, Angers, France
| | - Valerie Seegers
- Research and Statistics Department, Institut de Cancerologie de l’Ouest Paul Papin, Angers, France
| | - Pierre Yves Dubois
- Anesthesiology and Pain Department, Institut de Cancerologie de l’Ouest Paul Papin, Angers, France
| | - Marie Pechard
- Anesthesiology and Pain Department, Institut Curie, Paris, France
| | - Serge Robard
- Anesthesiology and Pain Department, Institut de Cancerologie de l’Ouest R. Gauducheau, St Herblain, France
| | - Thierry Delorme
- Anesthesiology and Pain Department, Institut de Cancerologie de l’Ouest Paul Papin, Angers, France
| | - Sabrina Jubier-Hamon
- Anesthesiology and Pain Department, Institut de Cancerologie de l’Ouest Paul Papin, Angers, France
| | - Gabriel Carvajal
- Anesthesiology and Pain Department, Institut de Cancerologie de l’Ouest Paul Papin, Angers, France
| | - Nathalie Lebrec
- Anesthesiology and Pain Department, Institut de Cancerologie de l’Ouest Paul Papin, Angers, France
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Sorrieul J, Robert J, Gibory V, Kieffer H, Folliard C, Dupoiron D, Devys C. Stability of sufentanil and baclofen mixtures for intrathecal analgesia at different concentrations in polypropylene syringes. Annales Pharmaceutiques Françaises 2018; 76:444-452. [DOI: 10.1016/j.pharma.2018.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/17/2018] [Accepted: 05/14/2018] [Indexed: 10/28/2022]
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Lorimier G, Seegers V, Coudert M, Dupoiron D, Thibaudeau E, Pouplin L, Lebrec N, Dubois PY, Dumont F, Guérin-Meyer V, Capitain O, Campone M, Wernert R. Prolonged perioperative thoracic epidural analgesia may improve survival after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases: A comparative study. Eur J Surg Oncol 2018; 44:1824-1831. [PMID: 30213715 DOI: 10.1016/j.ejso.2018.08.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/16/2018] [Accepted: 08/22/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To assess the effectiveness of prolonged perioperative thoracic epidural analgesia (PEA) on long term survival of patients who underwent a complete cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for colorectal peritoneal metastases (CPM). BACKGROUND Grade III-IV morbidity affects long term outcomes after CRS and HIPEC. As compared with opioid administered via patient-controlled analgesia (PCA), PEA reduces morbidity. METHOD From 2005 to 2016, 150 patients underwent CRS plus HIPEC with or without prolonged PEA. Clinical data and outcomes collected from prospective database were analyzed. Survival was assessed in terms of analgesic method using Kaplan-Meier plots and a propensity score. RESULTS Patients 'characteristics of 59 patients in PCA group were comparable to those of 91 patients in PEA group, except for age, ASA score and fluid requirements, significantly more important in PEA group. Grade III-IV morbidity was 62.7% in PCA group compared with 36.3% in PEA group (p = 0.0015). Median overall survival (OS) of PEA group was 54.7 months compared to 39.5 months in PCA group (p = 0.0078). When adjusted on the covariates, using the propensity score, the PEA significantly improves OS [HR 0.40 (95% CI: 0.28-0.56)] (p < 0.0001) and disease free survival (DFS) [HR 0.61 (95% CI: 0.45-0.81] (p < 0.0007) CONCLUSIONS: In this retrospective study of patients who underwent a complete CRS and HIPEC for colorectal peritoneal metastases, the perioperative thoracic epidural analgesia prolonged for over 72 h reduced significantly the grade III-IV morbidity and may improve OS and DFS.
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Affiliation(s)
- Gérard Lorimier
- Department of Surgical Oncology, Integrated Center of Oncology, Angers, France
| | - Valérie Seegers
- Department of Clinical Research, Integrated Center of Oncology, Angers, France.
| | - Marie Coudert
- Department of Medical Oncology, Integrated Center of Oncology, Angers, France
| | - Denis Dupoiron
- Department of Anesthesiology, Integrated Center of Oncology, Angers, France
| | - Emilie Thibaudeau
- Department of Surgical Oncology, Integrated Center of Oncology, Nantes, France
| | - Luc Pouplin
- Department of Anesthesiology, Integrated Center of Oncology, Nantes, France
| | - Nathalie Lebrec
- Department of Anesthesiology, Integrated Center of Oncology, Angers, France
| | - Pierre Yves Dubois
- Department of Anesthesiology, Integrated Center of Oncology, Angers, France
| | - Frédéric Dumont
- Department of Surgical Oncology, Integrated Center of Oncology, Nantes, France
| | | | - Olivier Capitain
- Department of Medical Oncology, Integrated Center of Oncology, Angers, France
| | - Mario Campone
- Department of Medical Oncology, Integrated Center of Oncology, Angers, France
| | - Romuald Wernert
- Department of Surgical Oncology, Integrated Center of Oncology, Angers, France
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Sorrieul J, Robert J, Gibory V, Collet M, Boutet M, Kieffer H, Folliard C, Dupoiron D, Devys C. Validated chromatographic method for the simultaneous determination of eight drugs (morphine, ropivacaine, bupivacaine, baclofen, clonidine, sufentanil, fentanyl and ziconotide) for intrathecal analgesia. Annales Pharmaceutiques Françaises 2018; 76:201-209. [DOI: 10.1016/j.pharma.2018.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 01/18/2018] [Accepted: 01/29/2018] [Indexed: 10/18/2022]
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Dupoiron D, Carvajal G. High-Resolution Three-Dimensional Computed Tomography Reconstruction as First-Line Imaging Modality to Detect Intrathecal Catheter Malfunction. Neuromodulation 2018; 21:717-720. [DOI: 10.1111/ner.12701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 08/21/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Denis Dupoiron
- Département Anesthésie-Douleur; Institut de Cancérologie de l'Ouest; site Paul Papin Angers France
| | - Gabriel Carvajal
- Département Anesthésie-Douleur; Institut de Cancérologie de l'Ouest; site Paul Papin Angers France
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Robert J, Sorrieul J, Kieffer H, Folliard C, Gibory V, Dupoiron D, Devys C. Stability Study of Morphine and Baclofen Solution in Polypropylene Syringes. Pharmaceutical Technology in Hospital Pharmacy 2017. [DOI: 10.1515/pthp-2017-0028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractBackgroundThe association of morphine and baclofen is used for the treatment of spasticity related pain. Moving these patients is sometimes difficult. In order to transport these syringes for pump refilling, it could be interesting to demonstrate the stability of the mixture, and so to be able to ensure the best transport conditions of syringes.MethodsA stability indicating UPLC-DAD method was developed and validated according to the ICH guidelines. Two mixtures of morphine and baclofen – a low concentration mixture (morphine 1 mg/mL – baclofen 0.08 mg/mL) and a high concentration mixture (morphine 10 mg/mL – baclofen 1.6 mg/mL) stored in 5±3 °C and 25±2 °C were evaluated for seven days and compared to the initial observed concentrations.ResultsThe stability of the low and high mixture is demonstrated for both storage conditions for seven days thanks to relative concentrations (95 % confidence intervals of the mean of 3 samples) systematically positioned between 95 % and 105 %. No degradation product was observed during the stability study.ConclusionThis study shows the stability of a weakly concentrated mixture and a highly concentrated mixture of morphine and baclofen. Extrapolation of these data to an intermediate mixture may be considered. Further studies will support this hypothesis. This result will allow the transport of the preparation under optimal conditions. Advance preparations for intrathecal pump refills could also be feasible.
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Dupoiron D. Rationale for Prospective Assays of Intrathecal
Mixtures Including Morphine, Ropivacaine and
Ziconotide: Prevention of Adverse Events and
Feasibility in Clinical Practice. ACTA ACUST UNITED AC 2017. [DOI: 10.36076/ppj.2015/18/349] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Use of intrathecal admixtures is widespread, but compounding these is sometimes
challenging and may result in errors and complications causing super-potency or sub potency
adverse events in patients or malfunctions in the pump itself.
Objective: The purpose of this study is to evaluate the accuracy of compounding of intrathecal
admixtures through a prospective, systematic quantitative analysis of each component of the
mixture before delivery to patients.
Study Design: Observational follow up prospective study of intrathecal mixtures components
concentrations before refills.
Settings: Assays were performed on all intrathecal admixtures produced by the ICO-Paul Papin
compounding pharmacy between January 2013 and October 2014 using Ultra High Performance
Liquid Chromatography (U.H.P.L.C.). In addition, pH levels of admixtures have been measured
since June 2014. When measured concentrations were 15% above or below the required
concentrations, the mixture was excluded and compounded again.
Results: 1729 mixtures were analyzed. Mean deviation from theoretical values was -1.17%
± 0.28% for morphine, -0.95% ± 1.07% for ropivacaine, and 4.82% ± 0.6% for ziconotide.
Exclusion rates were 8.33% overall, but fell from 11.67% in 2013 to 4.97% in 2014. Most
exclusions were caused by inaccuracy in the dose of ziconotide. Average mixture pH of the 603
tested admixtures was 4.83 ± 0.6%.
Limitations: This study is monocentric and limitations include also its non-randomized nature
with no clinical comparison of the rate of adverse events with a refill process without control of
each component concentrations.
Conclusion: Prospective assays provide benefits in ensuring accuracy of intrathecal mixture
compounding and in preventing overdosing or sub dosing, most notably concerning Ziconotide.
Key words: Intrathecal drug delivery, morphine, ziconotide, ropivacaine, prospective dosages,
adverse events prevention, quality process
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Affiliation(s)
- Denis Dupoiron
- Anesthesia and Pain Department, Institut de cancérologie de l’ouest - Paul Papin, Angers, France
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Robert J, Sorrieul J, Rossignol E, Beaussart H, Kieffer H, Folliard C, Dupoiron D, Devys C. Chemical Stability of Morphine, Ropivacaine, and Ziconotide in Combination for Intrathecal Analgesia. Int J Pharm Compd 2017; 21:347-351. [PMID: 28719378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Pain is the most feared symptom amongst individuals living with cancer. In 15% to 20% of patients, conventional analgesic therapy either fails to relieve pain or induces adverse effects. Intrathecal drug delivery systems may present an effective alternative for pain management. The Cancerology Center Paul Papin protocol includes an admixture of morphine, ropivacaine, and ziconotide in intrathecal preparations. These drugs are administered by a fully implantable or an external pump. Syringes or polyolefin infusion bags are prepared for refill just before use. Few centers in France use the method of intrathecal analgesia. Therefore, for those patients receiving intrathecal preparations, each filling requires that the patients be transported from their local hospital (or their home) to a referral center where the patients are monitored. They sometimes must travel up to a hundred kilometers to have a pump filled. The preparation and the analytical control of the mixture are carried out only by those centers meeting the proper criteria, which includes the proper equipment. To spare the patient this travel, a peripheral center may be subcontracted to manage the patient's pump refill. No data are available concerning the chemical stability of admixtures in syringes or polyolefin infusion bags. The aim of this study was to evaluate, with a new analytical method using ultra high-performance liquid chromatography, the chemical stability of these admixtures in syringes or in polyolefin infusion bags. Ziconotide 1 µg/mL was combined with ropivacaine (7.5 mg/mL) and morphine (3.5 mg/mL) in syringes at 5°C, 21°C, and 31°C, and in polyolefin infusion bags at 21°C. Assays were performed using ultra high-pressure liquid chromatography. In syringes stored at 21°C and 31°C, concentrations after 6 hours were not in the acceptable criterion of 10% variability. When syringes were stored at 5°C, the residual concentration of ziconotide after 3 days was 100.5% +/- 2.6% [92.7% to 108.4%]. In polyolefin infusion bags, the residual concentration of ziconotide after 14 days was 96.9% +/- 2.2% [90.1% to 103.6%]. This study demonstrates the chemical stability of this admixture in syringes stored at 5°C for 3 days and in polyolefin plastibags stored at 21°C for 14 days.
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Affiliation(s)
- Julien Robert
- Institute de Cancérologie de l'Ouest Paul Papin, Angers, France
| | - Jérémy Sorrieul
- Institute de Cancérologie de l'Ouest Paul Papin, Angers, France
| | - Elsa Rossignol
- Institute de Cancérologie de l'Ouest Paul Papin, Angers, France
| | | | - Hélène Kieffer
- Institute de Cancérologie de l'Ouest Paul Papin, Angers, France
| | | | - Denis Dupoiron
- Institute de Cancérologie de l'Ouest Paul Papin, Angers, France
| | - Catherine Devys
- Institute de Cancérologie de l'Ouest Paul Papin, Angers, France
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Dupoiron D, Stachowiak A, Loewenstein O, Ellery A, Kremers W, Bosse B, Hopp M. A phase III randomized controlled study on the efficacy and improved bowel function of prolonged-release (PR) oxycodone-naloxone (up to 160/80 mg daily) vs oxycodone PR. Eur J Pain 2017. [PMID: 28641363 PMCID: PMC5600007 DOI: 10.1002/ejp.1054] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Oxycodone/naloxone (OXN PR) is a prolonged-release formulation containing oxycodone and naloxone in a 2:1 ratio. This study aimed to evaluate the tolerability and efficacy of doses up to OXN160/80 mg PR compared with oxycodone prolonged-release formulation (OxyPR) in a randomised controlled trial. METHODS Two hundred and forty-three patients were randomised to treatment with OXN PR (n = 123) or OxyPR (n = 120) during the 5-week double-blind study. Measured were: opioid-induced constipation [bowel function index score (BFI)]; analgesic efficacy (NRS 0-10); daily laxative rescue medication use; rescue medication use, and the number of complete spontaneous bowel movements (CSBMs) per week. A subanalysis was conducted in cancer patients. RESULTS Greater reductions in mean BFI scores were reported for the OXN PR group compared with OxyPR from Week 1 onwards; at Week 5 the mean change from baseline was -32.5 versus -14.2. Average 24-h pain scores were low and remained stable in the range 3-4 in both treatment groups. Analgesic rescue medication use was similar between the groups. Patients receiving OXN PR used significantly lower mean daily doses of laxative rescue medication than those receiving OxyPR (P = 0.006). The number of CSBM in the OXN PR group approximately doubled compared with a 25% decrease in the OxyPR group. Comparable results to the total study population were reported in the cancer patient subgroup. CONCLUSIONS OXN PR in daily doses of up to 160/80 mg significantly improves bowel function compared with equivalent doses of OxyPR while still providing comparable analgesic efficacy. SIGNIFICANCE Effective analgesia can be achieved using oxycodone/naloxone PR up to 160/80 mg daily without compromising bowel function. A similar outcome was reported in cancer and non-cancer patients.
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Affiliation(s)
- D Dupoiron
- Département d'Anesthésie - Douleur, Institut de Cancérologie de l'Ouest - Paul Papin, Angers, France
| | - A Stachowiak
- Pallmed sp. z o.o., NZOZ Dom Sue Ryder, Bydgoszcz, Poland
| | - O Loewenstein
- Gemeinschaftspraxis Löwenstein - Dr. Hesselbarth, Schmerz- und Palliativzentrum DGS Mainz, Mainz, Germany
| | - A Ellery
- NHS Kernow Clinical Commissioning Group, Saint Austell, UK
| | - W Kremers
- Mundipharma Research GmbH & Co. KG, Limburg, Germany
| | - B Bosse
- Mundipharma Research GmbH & Co. KG, Limburg, Germany
| | - M Hopp
- Mundipharma Research GmbH & Co. KG, Limburg, Germany
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Dupoiron D, Stachowiak A, Loewenstein O, Ellery A, Kremers W, Bosse B, Hopp M. Long-term efficacy and safety of oxycodone-naloxone prolonged-release formulation (up to 180/90 mg daily) - results of the open-label extension phase of a phase III multicenter, multiple-dose, randomized, controlled study. Eur J Pain 2017; 21:1485-1494. [PMID: 28474460 PMCID: PMC5655918 DOI: 10.1002/ejp.1050] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2017] [Indexed: 12/12/2022]
Abstract
Background The inclusion of naloxone with oxycodone in a fixed combination prolonged‐release formulation (OXN PR) improves bowel function compared with oxycodone (Oxy) alone without compromising analgesic efficacy. In a recent 5‐week, randomized, double‐blind comparative trial of OXN PR and OxyPR, it could be shown that the beneficial properties of OXN PR extend to doses up to 160/80 mg. Methods Bowel function, pain, quality of life (QoL) and safety of OXN PR up to 180/90 mg daily were evaluated in a 24‐week open‐label extension phase of the 5‐week randomized comparative study in patients with non‐malignant or malignant pain requiring opioids and suffering from opioid‐induced constipation. Results During treatment with a mean (SD) daily dose OXN PR of 130.7 (26.56) mg (median, maximum: 120 and 180 mg), the Bowel Function Index (BFI) decreased from 45.3 (26.37) to 26.7 (21.37) with the largest decrease seen in the first week. The average pain over the last 24 h remained stable (median Pain Intensity Scale score 4.0) and QoL was maintained throughout the study. Adverse events were consistent with the known effects of OXN PR and no new safety concerns emerged. Equivalent efficacy and safety benefits were observed in cancer patients. Conclusions The OXN PR in doses up to 180/90 mg provides effective analgesia with maintenance of bowel function during long‐term treatment. The beneficial effects of such dose levels of OXN PR contribute to stable patient‐reported QoL and health status despite serious underlying pain conditions, such as cancer. Significance In patients with pain requiring continuous opioid therapy at doses above 80 mg of oxycodone, stable and effective long‐term analgesia can be achieved using OXN PR up to 180/90 mg daily without compromising bowel function and may be preferential to supplemental oxycodone.
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Affiliation(s)
- D Dupoiron
- Département d'Anesthésie - Douleur, Institut de Cancérologie de l'Ouest - Paul Papin, Angers, France
| | - A Stachowiak
- Pallmed sp. z o.o., NZOZ Dom Sue Ryder, Bydgoszcz, Poland
| | - O Loewenstein
- Gemeinschaftspraxis Löwenstein - Dr. Hesselbarth, Schmerz- und Palliativzentrum DGS Mainz, Mainz, Germany
| | - A Ellery
- NHS Kernow Clinical Commissioning Group, Saint Austell, UK
| | - W Kremers
- Mundipharma Research GmbH & Co. KG, Limburg, Germany
| | - B Bosse
- Mundipharma Research GmbH & Co. KG, Limburg, Germany
| | - M Hopp
- Mundipharma Research GmbH & Co. KG, Limburg, Germany
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Lorimier G, Linot B, Paillocher N, Dupoiron D, Verrièle V, Wernert R, Hamy A, Capitain O. Curative cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy in patients with peritoneal carcinomatosis and synchronous resectable liver metastases arising from colorectal cancer. Eur J Surg Oncol 2016; 43:150-158. [PMID: 27839895 DOI: 10.1016/j.ejso.2016.09.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 07/01/2016] [Accepted: 09/21/2016] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES This study describes the outcomes of patients with colorectal peritoneal carcinomatosis (PC) with or without liver metastases (LMs) after curative surgery combined with hyperthermic intraperitoneal chemotherapy, in order to assess prognostic factors. BACKGROUND Cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC) increases overall survival (OS) in patients with PC. The optimal treatment both for PC and for LMs within one surgical operation remains controversial. METHODS Patients with PC who underwent CRS followed by HIPEC were evaluated from a prospective database. Overall survival and disease free survival (DFS) rates in patients with PC and with or without LMs were compared. Univariate and multivariate analyses were performed to evaluate predictive variables for survival. RESULTS From 1999 to 2011, 22 patients with PC and synchronous LMs (PCLM group), were compared to 36 patients with PC alone (PC group). No significant difference was found between the two groups. The median OS were 36 months [range, 20-113] for the PCLM group and 25 months [14-82] for the PC group (p > 0.05) with 5-year OS rates of 38% and 40% respectively (p > 0.05). The median DFS were 9 months [9-20] and 11.8 months [6.5-23] respectively (p = 0.04). The grade III-IV morbidity and cytoreduction score (CCS) >0 (p < 0.05) were identified as independent factors for poor OS. Resections of LMs and CCS >0 impair significantly DFS. CONCLUSIONS Synchronous complete CRS of PC and LMs from a colorectal origin plus HIPEC is a feasible therapeutic option. The improvement in OS is similar to that provided for patients with PC alone.
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Affiliation(s)
- G Lorimier
- Integrated Center for Oncology Paul Papin, Angers, France
| | - B Linot
- Integrated Center for Oncology Paul Papin, Angers, France
| | - N Paillocher
- Integrated Center for Oncology Paul Papin, Angers, France
| | - D Dupoiron
- Integrated Center for Oncology Paul Papin, Angers, France
| | - V Verrièle
- Integrated Center for Oncology Paul Papin, Angers, France
| | - R Wernert
- Integrated Center for Oncology Paul Papin, Angers, France
| | - A Hamy
- Department of Surgery, University Hospital, Angers, France
| | - O Capitain
- Integrated Center for Oncology Paul Papin, Angers, France
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Staquet H, Dupoiron D, Nader E, Menei P. Intracerebroventricular Pain Treatment with Analgesic Mixtures including Ziconotide for Intractable Pain. Pain Physician 2016; 19:E905-E915. [PMID: 27454282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Intracerebroventricular (ICV) administration of opioids for control of intractable cancer pain has been used since 1982. We present here our experience of intracerebroventricular administration of pain treatments including ziconotide associated with morphine and ropivacaine for patients resistant to a conventional approach, with nociceptive, neuropathic, or mixed pain. These clinical cases were conducted with patients suffering from refractory pain, more than 6/10 on a numerical pain rating scale (NPRS) while on high-dose medical treatment and/or intolerance with significant side effects from oral medication. The baseline study visit included a physical examination and an assessment of pain intensity on a NPRS. Under general anesthesia, a neuronavigation device was used to place the catheter on the floor of the third ventricle, supported by an endoscope. Then, drugs were injected in the cerebroventricular system, through a pump (external or subcutaneous). The primary objective was to measure pain evaluation with ICV treatment after a complete withdrawal of other medications.Four patients were enrolled: 3 with intractable cancer pain and one with central neuropathic pain. The median NPRS at baseline was 9.5 [8.5; 19]. The mean NPRS after one month was 3.5 [3; 4.5]. Ziconotide was initiated at 0.48 µg/d and up to a median of 1.2 µg/d [1.0; 1.56]. The median dose of morphine and ropivacaine used initially was respectively 0.36 mg/d [0.24; 0.66] up to 0.6 mg/d [0.45; 4.63] and 1.2 mg/d [0; 2.4] up to 2.23 mg/d [1.2; 3.35]. Minor side effects were initially observed but transiently. One psychiatric agitation required discontinuation of ziconotide infusion. For intractable pain, using ziconotide by intracerebroventricular infusion seems safe and efficient, specifically for chronic neoplastic pain of cervicocephalic, thoracic, or diffuse origin and also for pain arising from a central neuropathic mechanism.
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Affiliation(s)
- Héléne Staquet
- Hopital Beaujon, Neurochirurgie, Clichy la Garenne, France, CHU d'Angers, Angers, France
| | - Denis Dupoiron
- Anesthesia and Pain Department, Institut de cancérologie de l'ouest - Paul Papin, Angers, France
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Sorrieul J, Gibory V, Dinh CP, Kieffer H, Folliard C, Dupoiron D, Devys C. Simultaneous Determination of Sufentanil and Ziconotide in Combination for Intrathecal Analgesia by UPLC-UV. Pharmaceutical Technology in Hospital Pharmacy 2016. [DOI: 10.1515/pthp-2016-0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractIntrathecal analgesia has increased over the past two decades based on high level proof of efficacy in patients with cancer. Morphine and Ziconotide remains the reference. Polyanalgesic Consensus Conference IT treatment algorithm recommends as the second line therapy opioids/ziconotide combination. Sufentanil and ziconotide combination can be used. The implantable pumps development helped to improve the comfort of the patient. The refills were prepared under a laminar airflow hood under strictly aseptic conditions, by the hospital pharmacist. In order to secure the process, a new analytical method by simple liquid chromatography ultraviolet spectrometry method was developed for the simultaneous quantification of two analgesic drugs (sufentanil, ziconotide). The method was validated according to the recommendation of the US Food and Drug Administration (FDA). The method was linear between 0.1 to 4 μg/mL for ziconotide and 3.125 to 50 µg/mL for sufentanil. This routine quality control analysis secures the production process.
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Beydon L, Rouxel A, Camut N, Schinkel N, Malinovsky JM, Aveline C, Marret E, Bildea A, Dupoiron D, Liu N, Daniel V, Darsonval A, Chrétien JM, Rault L, Bruna J, Alberti C. Sedative premedication before surgery – A multicentre randomized study versus placebo. Anaesth Crit Care Pain Med 2015; 34:165-71. [DOI: 10.1016/j.accpm.2015.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 01/21/2015] [Indexed: 10/23/2022]
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Marcy PY, Dahlet C, Brenet O, Yazbec G, Dubois PY, Salm B, Fouche Y, Mari V, Montastruc M, Lebrec N, Ancel B, Paillocher N, Dupoiron D, Rangeard O, Michel C, Chateau Y, Ettaiche M, Ferrero JM, Chamorey E. [Multicenter validation study of a questionnaire assessing patient satisfaction with and acceptance of totally-implanted central venous access devices]. Bull Cancer 2015; 102:301-15. [PMID: 25799876 DOI: 10.1016/j.bulcan.2015.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 01/29/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Most cancer patients require a totally-implanted central venous access device (TIVAD) for their treatment. This was a prospective, multicenter, open study to: (i) develop and validate a French-language questionnaire dubbed QASICC (Questionnaire for Acceptance of and Satisfaction with Implanted Central Venous Catheter) assessing patient's satisfaction with and acceptance of their TIVAD; (ii) develop a mean score of patient's acceptance and satisfaction; (iii) look for correlation between QASICC score and TIVAD patient/tumor pathology/device characteristics. METHODS From 2011 November to 2012 December, the first version of the QASICC questionnaire that included 27 questions assessing seven dimensions was re-tested among 998 cancer patients in eleven French cancer hospitals (eight cancer research institutes and three university/general hospitals). The goal was: (i) to reduce the questionnaire item and dimension number (pertinency, saturation effect, item correlation); (ii) to assess its psychometric properties, demonstrate its validity and independency compared to (EORTC) QLQC30; (iii) to correlate clinical and pathological patient's/tumor's/TIVAD's parameters with the QASICC questionnaire score (the higher the overall score, the greater the acceptance and satisfaction). The questionnaire was administered to the patient 30 days (±15 days) after TIVAD's implantation. RESULTS Among 998 questionnaires given to cancer patients, 658 were analyzed and 464 were fully assessed as there was no missing data. Time to fill-in the questionnaire was five minutes in 90% patients. Final QASICC tool included twenty-two questions assessing four homogeneous dimensions (65%<Cronbach coefficient<85%): (i) impact on daily activities and professional activities; (ii) esthetics and privacy; (iii) pain, contribution to the comfort of the treatment; (iv) local discomfort. Respective assessment scores were 23.6%, 32.9%, 20.4% and 18.0%. Overall satisfaction score was 75.8%; global assessment score was 76.2%. These scores were significantly linked to patient's gender, anesthesia type, TIVAD's implantation side, patient's age and tumor type. CONCLUSIONS This second and final methodological and statistical validation of this auto-questionnaire QASICC allows us to propose it as a dedicated questionnaire to TIVAD's cancer patients by using a score assessing acceptance and satisfaction regarding their device.
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Affiliation(s)
- Pierre Yves Marcy
- Centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 1, France.
| | - Christian Dahlet
- Centre Paul-Strauss, 03, rue de la Porte de l'Hôpital, 67065 Strasbourg cedex, France
| | - Olivier Brenet
- Centre Paul-Papin, ICO, 2, rue Moll, 49933 Angers cedex 9, France
| | - Gabriel Yazbec
- Institut Jean-Godinot, 01, avenue du Général-Koenig, BP171, 51056 Reims cedex, France
| | - Pierre Yves Dubois
- Institut Jean-Godinot, 01, avenue du Général-Koenig, BP171, 51056 Reims cedex, France
| | - Bernard Salm
- Centre Alexis-Vautrin, 6, avenue de Bourgogne, 54511 Vandœuvre-lès-Nancy, France
| | - Yves Fouche
- Centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 1, France
| | - Veronique Mari
- Hôpital de Jour, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 1, France
| | - Marion Montastruc
- Institut Claudius-Rigaud, 20-24, rue du Pont-Saint-Pierre, 31052 Toulouse cedex, France
| | - Nathalie Lebrec
- Centre Paul-Papin, ICO, 2, rue Moll, 49933 Angers cedex 9, France
| | - Benoit Ancel
- Centre Alexis-Vautrin, 6, avenue de Bourgogne, 54511 Vandœuvre-lès-Nancy, France
| | | | - Denis Dupoiron
- Centre Paul-Papin, ICO, 2, rue Moll, 49933 Angers cedex 9, France
| | - Olivier Rangeard
- Centre Alexis-Vautrin, 6, avenue de Bourgogne, 54511 Vandœuvre-lès-Nancy, France
| | - Cécile Michel
- Unité de recherche clinique, département de recherche clinique, innovation et statistiques, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 02, France
| | - Yann Chateau
- Unité d'épidémiologie et de biostatistiques, département de recherche clinique, innovation et statistiques, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 02, France
| | - Marc Ettaiche
- Unité d'épidémiologie et de biostatistiques, département de recherche clinique, innovation et statistiques, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 02, France
| | - Jean-Marc Ferrero
- Unité de recherche clinique, département de recherche clinique, innovation et statistiques, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 02, France
| | - Emmanuel Chamorey
- Unité d'épidémiologie et de biostatistiques, département de recherche clinique, innovation et statistiques, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 02, France
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Dupoiron D, Richard H, Chabert-Desnot V, Devys C, Leynia P, Boisdron-Celle M. In VitroStability of Low-Concentration Ziconotide Alone or in Admixtures in Intrathecal Pumps. Neuromodulation 2014; 17:472-82; discussion 482. [DOI: 10.1111/ner.12142] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 10/28/2013] [Accepted: 10/29/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Denis Dupoiron
- Anesthesia and Pain Department; Institut de cancérologie de l'ouest-Paul Papin; Angers France
| | - Hélène Richard
- Anesthesia and Pain Department; Institut de cancérologie de l'ouest-Paul Papin; Angers France
| | - Vincent Chabert-Desnot
- Oncopharmacology Laboratory; Institut de cancérologie de l'ouest-Paul Papin; Angers France
| | - Catherine Devys
- Pharmacy; Institut de cancérologie de l'ouest-Paul Papin; Angers France
| | - Pierre Leynia
- Pharmacy; Institut de cancérologie de l'ouest-Paul Papin; Angers France
| | - Michèle Boisdron-Celle
- Oncopharmacology Laboratory; Institut de cancérologie de l'ouest-Paul Papin; Angers France
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Abstract
Background: Ziconotide is a new analgesic agent administered intrathecally. It is challenging
to use and can induce several and sometimes serious adverse events. A low initial dosage
followed by slow titration may reduce serious adverse events.
Objective: To determine whether a low starting dosage of ziconotide, followed by slow
titration, decreases the incidence of major adverse events associated with ziconotide when
used for intractable cancer pain.
Study Design: Observational cohort study.
Setting: Three French cancer centers.
Methods: Patients with incurable cancer causing chronic pain rated above 6/10 on
a numerical scale while receiving high-dose opioid therapy (more than 200 mg/d of oral
morphine equivalent) and/or exhibiting severe opioid-related adverse events received
intrathecal infusions of ziconotide combined with morphine, ropivacaine, and clonidine.
Results: Seventy-seven patients were included. Adverse events were recorded in 57%
of them; moderate adverse events occurred in 51%. Adverse events required treatment
discontinuation in 7 (9%) including 5 (6%) for whom a causal role for ziconotide was highly
likely; among them 4 (5%) were serious. All patients experienced a significant and lasting
decrease in pain intensity (by 48%) in response to intrathecal analgesic therapy that included
ziconotide.
Limitations: Limitations include the nonrandomized, observational nature of the study.
Determining the relative contributions of each drug to adverse events was difficult, and some
of the adverse events manifested as clinical symptoms of a subjective nature.
Conclusions: The rates of minor and moderate adverse events were consistent with
previous reports. However, the rate of serious adverse events was substantially lower. Our
study confirms the efficacy of intrathecal analgesia with ziconotide for relieving refractory
cancer pain. These results indicate that multimodal intrathecal analgesia in patients with
cancer pain should include ziconotide from the outset in order to provide time for subsequent
slow titration.
Key words: Ziconotide, adverse events, intrathecal therapy, cancer pain, morphine,
ropivacaine, clonidine.
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Affiliation(s)
- Denis Dupoiron
- Department of Anesthesia and Pain – Institut de Cancérologie de l’Ouest - Angers, France
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Dupoiron D, Bore F, Lefebvre-Kuntz D, Brenet O, Debourmont S, Dixmerias F, Buisset N, Lebrec N, Monnin D. Ziconotide adverse events in patients with cancer pain: a multicenter observational study of a slow titration, multidrug protocol. Pain Physician 2012; 15:395-403. [PMID: 22996851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Ziconotide is a new analgesic agent administered intrathecally. It is challenging to use and can induce several and sometimes serious adverse events. A low initial dosage followed by slow titration may reduce serious adverse events. OBJECTIVE To determine whether a low starting dosage of ziconotide, followed by slow titration, decreases the incidence of major adverse events associated with ziconotide when used for intractable cancer pain. STUDY DESIGN Observational cohort study. SETTING Three French cancer centers. METHODS Patients with incurable cancer causing chronic pain rated above 6/10 on a numerical scale while receiving high-dose opioid therapy (more than 200 mg/d of oral morphine equivalent) and/or exhibiting severe opioid-related adverse events received intrathecal infusions of ziconotide combined with morphine, ropivacaine, and clonidine. RESULTS Seventy-seven patients were included. Adverse events were recorded in 57% of them; moderate adverse events occurred in 51%. Adverse events required treatment discontinuation in 7 (9%) including 5 (6%) for whom a causal role for ziconotide was highly likely; among them 4 (5%) were serious. All patients experienced a significant and lasting decrease in pain intensity (by 48%) in response to intrathecal analgesic therapy that included ziconotide. LIMITATIONS Limitations include the nonrandomized, observational nature of the study. Determining the relative contributions of each drug to adverse events was difficult, and some of the adverse events manifested as clinical symptoms of a subjective nature. CONCLUSIONS The rates of minor and moderate adverse events were consistent with previous reports. However, the rate of serious adverse events was substantially lower. Our study confirms the efficacy of intrathecal analgesia with ziconotide for relieving refractory cancer pain. These results indicate that multimodal intrathecal analgesia in patients with cancer pain should include ziconotide from the outset in order to provide time for subsequent slow titration.
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Dupoiron D, Lefebvre-kuntz D, Brenet O, de Bourmont S, Grelon F, Dixmeria F, Buisset N, Lebrec N, Bore F, Monnin D. Douleur chronique cancéreuse et analgésie intrathécale : expérience de trois centres de lutte contre le cancer. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.douler.2011.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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