用树脂胺毒素治疗吸收性癌症疼痛 - 一项临时研究
Andrew J Mannes1, John D Heiss2, Ann Berger3
1Department of Perioperative Medicine, Clinical Center, National Institutes of Health, Bethesda, MD.
NEJM evidence
|May 27, 2025
概括
作为一种非阿片类止痛药的树脂胺毒素 (RTX) 在晚期癌症患者中显示出显著的疼痛减轻和阿片类药物节约. 虽然发生了不良事件,但RTX为难以治疗的癌症疼痛管理提供了有希望的选择.
科学领域:
- 神经科学是一个神经科学.
- 药理学 药理学是指药理学的学科.
- 在瘤学瘤学.
背景情况:
- 晚期癌症经常导致耐火性疼痛,挑战目前的治疗方法.
- 树脂胺毒素 (RTX) 是TRPV1的激动剂,它向特定的神经元,以中断疼痛信号传递.
- 评估RTX为严重的癌症疼痛提供了一个潜在的非阿片类药物替代品.
研究的目的:
- 评估内树脂蛋白毒素 (RTX) 在耐火性癌症患者的安全性和有效性.
- 评估RTX作为一种非阿片类止痛药,用于难治性疼痛管理.
- 确定RTX对疼痛强度和阿片类药物消费的影响.
主要方法:
- 第1期,开放标签,首次在人体上进行的研究,涉及19名耐火性癌症疼痛患者.
- 单次静脉注射RTX给腹部和/或下肢疼痛的患者.
- 通过治疗出现的不良事件来评估安全性;通过疼痛强度 (数值评分表) 和阿片类药物消耗 (吗啡等价物) 来衡量疗效.
主要成果:
- 在RTX治疗后观察到,最严重的疼痛强度减少了38%,阿片类药物消费减少了57%.
- 常见的不良事件包括感官丧失和尿路滞留;发生9例死亡,与晚期癌症进展一致.
- 在5名患者中观察到过渡性心电图QT间隔变化,在24小时内消失.
结论:
- 内RTX提供了一次性,阿片类药物节约的止痛效应,用于难以治疗的癌症疼痛.
- 该研究观察到预期和意想不到的不良事件,对缓解疼痛产生了令人鼓舞的初始影响.
- RTX代表了一种潜在的新型治疗策略,用于管理耐火性癌症疼痛,需要进一步调查.
相关概念视频
Treatment Resistant Cancers
3.4K
Cancer is the second leading cause of death in the United States. A cancer cell is genetically unstable and hence can mutate faster. They can also modify their microenvironment and escape immune surveillance. The difficulties in treating cancer are further compounded by the emergence of rapid resistance to anticancer drugs. The most common ways to attain resistance in cancer cells include alteration in drug transport and metabolism, modification of drug target, elevated DNA damage response, or...
3.4K
Chemotherapy-Induced Nausea and Vomiting: Cannabinoids
372
Tetrahydrocannabinol (THC) is a phytocannabinoid that primarily interacts with the CB1 receptor, a type of G protein-coupled receptor (GPCR) predominantly in and around the chemoreceptor trigger zone (CTZ) and emetic center. THC also blocks the serotonin receptor activity in the dorsal vagal complex (DVC) by inhibiting serotonin release. THC exerts its anti-emetic effects through these interactions, which are beneficial for patients undergoing chemotherapy.
Two synthetic agonists of THC,...
Two synthetic agonists of THC,...
372
Analgesia and Pain Management
823
Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
823
Chemotherapy-Induced Nausea and Vomiting: Neurokinin-1 Receptor Antagonists
267
Neurokinin 1 (NK1) receptors are distributed across the GI tract, vagal afferents, and key CNS regions including the central vomiting center and chemoreceptor trigger zone (CTZ) Chemotherapy agents stimulate enterochromaffin cells in the gastrointestinal (GI) tract to release large amounts of substance P (SP). SP is a neuropeptide released by specific sensory nerves in response to many different stressors, including those in the GI mucosa affected by chemotherapy. SP binds and activates...
267
Opioid Analgesics: Synthetic and Semisynthetic Opioids
454
Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
454


