Current medical research and opinion
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Breakthrough pain (BTP) is a transitory flare of moderate-to-severe pain that occurs in patients with stable, controlled persistent pain. Management of BTP episodes is difficult because frequency, time-to-peak intensity, and duration of episodes vary both within and between individuals. Formulations of fentanyl that use a buccal, sublingual, or nasal transmucosal route of administration have been developed for the treatment of BTP in opioid-tolerant patients with cancer. These formulations allow rapid passage into the bloodstream and avoid first-pass metabolism and, therefore, are more likely to match the time-course of BTP episodes than are oral formulations. The purposes of this analysis were to identify and review published data describing the pharmacokinetic properties of rapid-onset fentanyl formulations and to evaluate these properties in view of the temporal dynamic characteristics of BTP in order to help guide medical practice. ⋯ Given the substantial variability of BTP episodes experienced by patients, these pharmacokinetic differences may provide useful information for a physician who is selecting a rapid-onset opioid medication for a patient.
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Lack of response in some patients and relapse during the course of therapy in the treatment of HER2-positive early breast cancer and metastatic breast cancer continue to challenge researchers and clinicians towards a better understanding of the fundamental mechanisms of trastuzumab action and new therapies for HER2. The aim of this review is to discuss current and future treatment options with pertuzumab in the light of new insights into HER2-positive breast cancer. ⋯ Pertuzumab is the first HER dimerization inhibitor with a mechanism of action complementary to trastuzumab. Studies with anti-HER2 combination treatments indicate that the use of more than one HER2-targeted therapy was superior to one of these agents alone. Pertuzumab has produced impressive anti-tumor activity in combination with trastuzumab. There are ongoing studies with pertuzumab with an increasing tendency towards moving the study of these agents to earlier stages of the disease, namely in the adjuvant and neoadjuvant setting.
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Gefitinib is a well known therapy for non-small-cell lung cancer (NSCLC). The purpose of this study was to review clinical reports of gefitinib as maintenance therapy after first-line chemotherapy regardless of epidermal growth factor receptor (EGFR) mutation, and assess its efficacy and safety in Chinese patients. ⋯ Gefitinib produced encouraging efficacy, safety and survival when delivered as maintenance therapy for NSCLC in Chinese patients after first-line chemotherapy regardless of EGFR mutation, especially for the patients who were female, non-smokers, LAC and with rash. Key limitations of this review include limited subgroup data, small sample sizes, and the lack of EGFR/KRAS data.
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Review
Continuing evolution of opioid use in primary care practice: implications of emerging technologies.
Primary care physicians, nurse practitioners, and nurses are often the first to evaluate patients with pain and many patients depend on these clinicians for pain relief. The growing evidence supporting use of opioids for appropriately selected patients means that primary care practitioners must be knowledgeable regarding ever-evolving pain-management strategies. ⋯ The strategic use of new opioid formulations and better patient assessment may lead to more successful use of opioids in the management of pain, while limiting or lowering the risk of the development of an addiction problem, abuse or diversion.
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To date, there are no systematic reviews of epidemiological studies of chronic pain in the developing world. ⋯ The review provides further evidence that the prevalence of chronic pain in the general population is high. However, there was insufficient reliable data to estimate with any certainty the prevalence of chronic pain in countries with an HDI < 0.9 with variability in estimates between surveys being of concern. Subtle differences in review and survey methodology appeared to impact markedly on estimates. There is a need for epidemiological studies that estimate the prevalence of chronic pain in developing countries to determine the scale of the problem.