Reddy Akhila, Haider Ali, Arthur Joseph, Hui David, Dalal Shalini, Dev Rony, Tanco Kimberson, Amaram-Davila Jaya, Hernandez Farley, Chavez Paul, De Moraes Aline Rozman, Wu Jimin, Nguyen Kristy, Subbiah Ishwaria, Epner Daniel, Shelal Zeena, Guay Marvin Omar Delgado, Mallipeddi Tarun, Bruera Eduardo
Department of Palliative Care and Rehabilitation Medicine (A.R., A.H., J.A. D.H., S.D., R.D., K.T., J.A-D., F.H., P.C., A.R.D.M., K.N., I.S., D.E., Z.S., M.O.D.G., E.B.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Department of Palliative Care and Rehabilitation Medicine (A.R., A.H., J.A. D.H., S.D., R.D., K.T., J.A-D., F.H., P.C., A.R.D.M., K.N., I.S., D.E., Z.S., M.O.D.G., E.B.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
J Pain Symptom Manage. 2023 Jun;65(6):e683-e690. doi: 10.1016/j.jpainsymman.2023.01.013. Epub 2023 Jan 28.
Levorphanol is a potent opioid agonist and NMDA receptor blocker with minimal drug interactions, and there are few reports of its use in cancer patients.
We aimed to determine the frequency of successful opioid rotation (OR) to levorphanol and the median opioid rotation ratio (ORR) from Morphine Equivalent Daily Dose (MEDD).
This is a prospective, single-group, interventional study. Cancer outpatients requiring an OR and receiving a MEDD of 60-300 mg were rotated to levorphanol using a ratio of 10:1 and assessed daily for 10-day. Successful OR was defined as a 2-point improvement in the Edmonton Symptom Assessment System (ESAS) pain score on day 10 or achieving the personalized pain goal between days 3-10 in patients with uncontrolled pain or resolution of opioid side effects (OSE) in those undergoing OR for OSE alone. The ORR to levorphanol was calculated using net-MEDD (MEDD before OR minus the MEDD of the breakthrough opioid used along with levorphanol after OR).
Forty patients underwent OR to levorphanol, and uncontrolled pain 35/40 (87.5%) was the most common indication. The median net-MEDD and levorphanol doses were 95 and 10 mg, respectively, and 33/40 (82.5%) had a successful OR with a median (IQR) ORR of 8.56 (7.5-10). Successful OR was associated with significant improvement in ESAS and OSE scale scores. There was a strong association between MEDD and levorphanol dose.
This study provided preliminary data that cancer patients could be successfully rotated to levorphanol using an ORR of 8.5. Levorphanol was associated with improved pain and symptom control and was well- tolerated.
左啡诺是一种强效阿片类激动剂和N-甲基-D-天冬氨酸（NMDA）受体阻滞剂，药物相互作用极少，关于其在癌症患者中的应用报道较少。
我们旨在确定成功转换为左啡诺的阿片类药物轮换（OR）频率以及吗啡等效日剂量（MEDD）的阿片类药物轮换中位数比率（ORR）。
这是一项前瞻性、单组、干预性研究。需要进行OR且MEDD为60 - 300mg的癌症门诊患者按10:1的比例转换为左啡诺，并连续10天每日进行评估。成功的OR定义为：在第10天埃德蒙顿症状评估系统（ESAS）疼痛评分提高2分；或在第3 - 10天，疼痛未得到控制的患者达到个性化疼痛目标；或仅因阿片类药物副作用（OSE）进行OR的患者中OSE得到缓解。左啡诺的ORR通过净MEDD计算（OR前的MEDD减去OR后与左啡诺一起使用的突破性阿片类药物的MEDD）。
40例患者进行了转换为左啡诺的OR，其中35/40（87.5%）疼痛未得到控制是最常见的适应证。净MEDD中位数和左啡诺剂量分别为95mg和10mg，33/40（82.5%）患者OR成功，ORR中位数（IQR）为8.56（7.5 - 10）。OR成功与ESAS和OSE量表评分显著改善相关。MEDD与左啡诺剂量之间存在强关联。
本研究提供了初步数据，表明癌症患者可以使用8.5的ORR成功转换为左啡诺。左啡诺与疼痛和症状控制改善相关，且耐受性良好。
