Fentanyl Buccal Tablet for the Relief of Episodic Breathlessness in Cancer Patients
Status:
Completed
Trial end date:
2014-12-01
Target enrollment:
Participant gender:
Summary
"Episodic breathlessness (or dyspnea) is one form of chronic refractory breathlessness
characterized by a severe worsening of breathlessness intensity or unpleasantness beyond
usual fluctuations in the patient's perception. Episodes are time-limited (seconds to hours)
and occur intermittently, with or without underlying continuous breathlessness. Episodes may
be predictable or unpredictable, depending on whether any trigger(s) can be identified. There
is a range of known triggers which can interact (e.g. exertion, emotions, comorbidities or
external environment). One episode can be caused by one or more triggers." ( definition by an
international expert consensus [Simon et al. 2013]). Approximately half of patients with
cancer complain about breathlessness with the highest prevalence in pulmonary malignancies.
Episodic breathlessness is reported by 81% of breathless cancer patients with significant
impairment on quality of life and limitations on activity. Although episodic breathlessness
show some similar characteristics like episodes of pain (breakthrough cancer pain, BTCP;
median duration 30minutes), they are often shorter: 91% last less than 20minutes (min). Other
evidence supports these findings with duration between 2-15minutes which is a real challenge
for the treatment of episodic breathlessness. In the majority of cases, episodic
breathlessness occur 1-4 times per day and peak intensity is rated moderate or severe.
There is evidence for the effectiveness of opioids for the relief of chronic refractory
breathlessness. There is no evaluated and proven standard treatment for the relief of
episodic breathlessness at the moment but immediate-release morphine (IRM) as solution or
tablet is most frequently used in clinical practice to treat episodic breathlessness. Time to
onset of action of IRM is about 20-30min for pain. Fentanyl is a potent opioid and shows good
evidence for the treatment of BTCP through its quick onset of action (5-15min) and short
duration of action (50-60min). Because of its pharmacodynamic properties fentanyl might be
appropriate and effective for the relief of episodic breathlessness. However, the efficacy of
fentanyl for the relief of breathlessness and time to onset is unknown.
This pilot study aims to evaluate relative efficacy, feasibility and time to onset of two
different opioids (fentanyl and morphine) in order to improve the management of episodic
breathlessness.
Phase:
Phase 2
Details
Lead Sponsor:
University of Cologne
Collaborators:
Teva Branded Pharmaceutical Products R&D, Inc. Teva Pharmaceutical Industries