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Insights into the Use of Peripherally Acting μ-Opioid Receptor Antagonists (PAMORAs) in Oncologic Patients: from Scientific Evidence to Real Clinical Practice

  • Palliative and Supportive Care (MP Davis, Section Editor)
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

Management of chronic pain is crucial to improve the quality of life of cancer and palliative care patients. Opioid-based treatments used to control pain can be prolonged over time. Unfortunately, constipation is one of the most disturbing adverse effects of long-term use of opioids. Opioid-induced constipation (OIC) occurs when opioids bind to the specific receptors present in the gastrointestinal (GI) tract, and can affect any patients receiving chronic opioid therapy, including cancer patients. The limited efficacy of laxatives to treat OIC symptoms prompted the search for new therapeutic strategies. Peripherally acting μ-opioid receptor antagonists (PAMORAs) have recently emerged as new effective drugs for OIC management due to their specific binding to enteric μ-receptors. Little information is available on the use of PAMORAs in real-life practice for OIC treatment in cancer patients. In this paper, a panel of experts specializing in cancer and palliative care pools their clinical experience with PAMORAs in cancer patients presenting OIC and highlights the importance of timing and choice of therapy in achieving prompt OIC management and benefitting patients.

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Acknowledgments

The authors thank Dr. Susana Cañón, (Medical Statistics Consulting, S.L., Valencia, Spain) for providing medical writing support in accordance with Good Publication Practice (GPP3) guidelines, which was funded by Kyowa Kirin Farmacéutica S.L.U. (Madrid, Spain).

Funding

The authors disclose receipt of the following financial support for the research, authorship, and publication of this article: Kyowa Kirin Farmacéutica S.L.U. supported this work but had no role in the preparation of the manuscript.

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Authors and Affiliations

  1. Medical Oncology, Complexo Hospitalario de Ourense, Ramón Puga, 54, 32003, Orense, Spain

    Ana Fernández-Montes MD

  2. Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain

    Guillermo de Velasco MD, PhD

  3. Medical Oncology, Complejo Hospitalario Universitario de Santiago de Compostela, La Coruña, Spain

    Santiago Aguín MD

  4. Palliative Care Unit, Hospital del Mar, Barcelona, Spain

    Cristina Farriols MD

  5. Medical Oncology, Hospital General Universitario de Elche, Alicante, Spain

    María Guirado-Risueño MD

  6. Oncology Radiotherapy Unit, Hospital Universitario Clínico San Cecilio, Granada, Spain

    Vanessa G. Jerviz-Guía MD

  7. Palliative Unit Care, Complejo Hospitalario Universitario, Toledo, Spain

    María Victoria Baeza-Nadal MD

  8. Radiation Oncology, Hospital Universitario Doctor Negrín, Las Palmas de Gran Canaria, Spain

    Rodolfo Chicas-Sett MD, PhD

  9. Medical Oncology, Hospital Cosaga, Orense, Spain

    José Luis Fírvida MD

  10. Medical Oncology, Hospital Universitario Son Llàtzer, Palma, Palma de Mallorca, Islas Baleares, Spain

    Francisco García-Navalón MD

  11. Medical Oncology, Hospital Marina Baixa de Villajoyosa, Alicante, Spain

    Patricia Martín MD

  12. Medical Oncology, Hospital del Henares, Madrid, Spain

    Carmen Perezagua-Marín MD, PhD

  13. Palliative Care Unit, Hospital Universitario de Sant Joan de Reus, Tarragona, Spain

    Dulce Rodríguez MD

  14. Palliative Care Unit, Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares, Spain

    Joan Santamaría MD

  15. Medical Oncology, Hospital Clínic, Barcelona, Spain

    Tamara Saurí MD, PhD

  16. Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain

    Tamara Saurí MD, PhD

  17. Medical Oncology, Hospitales Universitarios Regional y Virgen de la Victoria, IBIMA, Málaga, Spain

    Manuel Cobo MD, PhD

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  1. Ana Fernández-Montes MD
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Correspondence to Ana Fernández-Montes MD.

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Conflict of Interest

All authors have received compensation from Kyowa Kirin Farmacéutica S.L.U. for service as consultants. Ana Fernández-Montes has received grants from Kyowa Kirin outside the submitted work. José Luis-Fírvida has received compensation from Astra Zeneca, Bristol-Myers Squibb, Lilly, Roche, and Takeda for service as consultant, not related to the submitted work. Guillermo de Velasco has received grants/ personal fees from Pfizer, Roche, Ipsen, Astellas, Bayer, Bristol-Myers Squibb, Novartis, Janssen, Merck Sharp & Dohme, and Merck, outside the submitted work. Santiago Aguín has received personal personal fees from Merck, Merck Sharp & Dohme, and Bristol-Myers Squibb, outside the submitted work. José Luis Fírvida has received compensation from Astra Zeneca, Bristol Myers Squibb, Lilly, Merck Sharp & Dohme, Roche, and Takeda for service as consultant, not related to the submitted work. María Guirado-Risueño has received personal fees and non-financial support from Kyowa Kirin and Roche and personal fees from Merck Sharp & Dohme, Bristol-Myers Squibb, and Astra Zeneca, outside the submitted work.

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Fernández-Montes, A., de Velasco, G., Aguín, S. et al. Insights into the Use of Peripherally Acting μ-Opioid Receptor Antagonists (PAMORAs) in Oncologic Patients: from Scientific Evidence to Real Clinical Practice. Curr. Treat. Options in Oncol. 22, 26 (2021). https://doi.org/10.1007/s11864-021-00816-5

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