• Sebastiano Mercadante.
• a Anesthesia & Intensive Care and Pain Relief & Palliative Care Unit , La Maddalena Cancer Center , Palermo , Italy.
• Curr Med Res Opin. 2017 Nov 1; 33 (11): 1965-1969.

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

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