Drugs
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Review
Transdermal matrix fentanyl membrane patch (matrifen): in severe cancer-related chronic pain.
The matrix fentanyl membrane patch is a new transdermal patch designed with a reduced drug load compared with established reservoir and matrix fentanyl patches. The drug is contained within a silicone matrix with a rate-controlling membrane designed to maintain constant serum fentanyl concentrations over the 72-hour application period. ⋯ In a randomized, nonblind, multicentre trial, the transdermal matrix fentanyl membrane patch was noninferior to standard opioid therapy (transdermal reservoir or matrix fentanyl patch or an oral opioid) in terms of analgesic efficacy over 30 days in patients with cancer-related chronic pain requiring long-term opioid use. The transdermal matrix fentanyl membrane patch was as well tolerated as standard opioid therapy; patient-rated tolerability scores for constipation, nausea, daytime drowsiness and sleep disturbance were similar between treatments.
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Zoledronic acid (Zometa), a third-generation amino-bisphosphonate, has been approved in the US, the EU and many other countries worldwide for the prevention of skeletal-related events in patients with bone metastases of malignancy. In several well designed trials, zoledronic acid 4 mg administered as a 15-minute infusion every 3-4 weeks was effective in reducing the occurrence of skeletal complications in patients with bone metastases secondary to multiple myeloma, breast cancer or prostate cancer. Zoledronic acid was as effective as pamidronic acid in reducing the occurrence of skeletal complications in patients with multiple myeloma or breast cancer. ⋯ Zoledronic acid is generally well tolerated; the risk of osteonecrosis of the jaw may be minimized by adhering to recommendations regarding dental therapy. Additional efficacy and economic data are required to definitively position zoledronic acid with respect to other bisphosphonates. Nevertheless, available clinical data indicate that zoledronic acid is an effective treatment option for the management of bone metastases of malignancy.
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The underlying problem in idiopathic thrombocytopenic purpura (ITP) has traditionally been recognized as accelerated platelet destruction. However, recent studies have provided evidence that the pathophysiology of ITP is more complex, and impaired platelet production has emerged as one of the mechanisms contributing to the thrombocytopenia. On these grounds, second-generation thrombopoietic agents have been used in clinical trials to stimulate platelet production in ITP patients who are not responsive to standard treatments. ⋯ No significant adverse events were seen. Other thrombopoietic agents in development, such as AKR-501 (formerly YM 477), appear promising in healthy volunteers. Ongoing phase III clinical trials will reveal the potential of these agents in the management of ITP prior to splenectomy and for long-term maintenance therapy, as well as their relative benefit compared with standard of care treatment.
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Sorafenib is an orally active multikinase inhibitor with anti-tumour activity. It was recently approved in the US and the EU for the treatment of patients with hepatocellular carcinoma. Oral sorafenib 400 mg twice daily significantly improved survival in patients with advanced hepatocellular carcinoma in the randomized, double-blind, multicentre, phase III SHARP trial (n = 602); the median duration of survival was 10.7 months with sorafenib and 7.9 months with placebo. ⋯ Combination therapy with oral sorafenib 400 mg twice daily and intravenous doxorubicin has potential in the treatment of patients with advanced hepatocellular carcinoma, according to the results of a randomized, double-blind, phase II study (n = 96). Although the addition of sorafenib to doxorubicin did not significantly delay the time to progression, the median durations of overall survival and progression-free survival were significantly longer with sorafenib plus doxorubicin than with doxorubicin alone. Monotherapy with oral sorafenib 400 mg twice daily was generally well tolerated in patients with advanced hepatocellular carcinoma, with a manageable adverse event profile.
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Lung cancer continues to be the leading cause of cancer death in Western countries. The median survival time for advanced non-small cell lung cancer (NSCLC) remains poor and chemotherapy is the treatment of choice for most patients with metastatic NSCLC. Platinum-based chemotherapy has long been the standard of care for advanced NSCLC. ⋯ Bevacizumab has also been investigated in combination with erlitonib as second-line treatment in two small early phase trials, with interesting results. Bevacizumab was generally well tolerated in clinical trials; the main treatment-associated adverse events were neutropenia and haemorrhage, especially in the lung, but also at other sites. Several trials that incorporate bevacizumab in combination with new active drugs in NSCLC are ongoing and should further help to define the place of bevacizumab in the therapy of NSCLC.