Kreye Gudrun, Masel Eva-Katharina, Hackner Klaus, Stich Beate, Nauck Friedemann
Division of Palliative Care, Department of Internal Medicine 2, University Hospital, Karl Landsteiner University of Health Sciences, Mitterweg 10, 3500, Krems an der Donau, Austria.
Division of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
Wien Med Wochenschr. 2018 May;168(7-8):159-167. doi: 10.1007/s10354-018-0623-5. Epub 2018 Feb 19.
Recently, the use of methadone in cancer patients has increased due to in vitro studies indicating that methadone is capable of inducing cell death. However, thus far there are no relevant clinical studies indicating that the use of methadone can prolong survival in cancer patients. Based on low-quality evidence, methadone is a drug that has similar analgesic benefits to morphine and has a role in the management of cancer pain in adults. Other opioids such as morphine, hydromorphone, and fentanyl are easier to manage but may be more expensive than methadone in many economies. Methadone is an opioid that is only approved for replacement therapy in Austria. Methadone can be used as a second- or third-line agent for severe cancer-related pain, but its use should be restricted to experts. Here we report a series of cases of patients who developed problems when using methadone as an antitumor treatment, with a brief review on the role of methadone as a pain medication and the current lack of value as an anti-tumor therapy. Methadone is not approved or recommended as an anticancer treatment in Austria or Germany. The Austrian Association for Hemato-oncology (OeGHO), the Austrian Association for the Management of Pain (ÖSG), and the Austrian Association for Palliative Care (OPG) do not recommend the use of methadone as an anticancer treatment. Thus, from a medical and ethical point of view, the use of methadone as an antitumor therapy is to be rejected, based on the views of various Austrian (OeGHO, ÖSG, OPG) and German specialists. Unqualified use of methadone by nonexperienced pain therapists is dangerous and must also be rejected.
最近，由于体外研究表明美沙酮能够诱导细胞死亡，癌症患者中美沙酮的使用有所增加。然而，迄今为止，尚无相关临床研究表明使用美沙酮可延长癌症患者的生存期。基于低质量证据，美沙酮是一种与吗啡具有相似镇痛效果的药物，在成人癌症疼痛管理中发挥作用。其他阿片类药物，如吗啡、氢吗啡酮和芬太尼，管理起来更容易，但在许多经济体中可能比美沙酮更昂贵。美沙酮是一种阿片类药物，仅在奥地利被批准用于替代疗法。美沙酮可作为重度癌症相关疼痛的二线或三线药物，但使用应限于专家。在此，我们报告了一系列患者在将美沙酮用作抗肿瘤治疗时出现问题的病例，并简要回顾了美沙酮作为止痛药的作用以及目前作为抗肿瘤疗法缺乏价值的情况。在奥地利或德国，美沙酮未被批准或推荐用于抗癌治疗。奥地利血液肿瘤学会（OeGHO）、奥地利疼痛管理协会（ÖSG）和奥地利姑息治疗协会（OPG）均不推荐使用美沙酮进行抗癌治疗。因此，从医学和伦理角度来看，基于奥地利（OeGHO、ÖSG、OPG）和德国各专家的观点，应拒绝将美沙酮用作抗肿瘤疗法。经验不足的疼痛治疗师不合格地使用美沙酮是危险的，也必须予以拒绝。
