House Call: Methylnaltrexone in Cancer Patients


Filip Janku, MD, PhD, discusses new post hoc analyses for the opioid receptor antagonist in advanced-illness patients.

A post hoc analysis from earlier this year showed opioid receptor antagonist methylnaltrexone (Relistor) significantly improved opioid-induced constipation (OIC) versus placebo in advanced-illness patients—regardless of whether they had a cancer diagnosis.

The analysis, conducted by a US-based team of investigators led by Bruce H. Chamberlain, MD, of Genesis Healthcare, show patients with advanced cancer or nonmalignant illness may achieve a similar benefit for OIC with subcutaneous methylnaltrexone. The drug showed consistently rapid benefit and no withdrawal effects.

What’s to be made of these findings—and how do they influence the current clinical understanding and use of methylnaltrexone in patients on opioids for cancer-related pain?

In a House Call video interview with HCPLive®, Filip Janku, MD, PhD, Associate Professor in the Department of Investigational Cancer Therapeutics and Center Medical Director for the Clinical and Translation Research Center at MD Anderson Cancer Center, broke down the cohort findings page-by-page.

Janku discussed the past decade of clinical research into methylnaltrexone, the strengths and limitations of the analysis, and what he’d like to see come from clinical trials following these findings.

“From the utility of this data and from the prescribing practices, there’s probably enough data to provide validation, confirmation,” Janku said. “I really think the next step really should be to look into the survival.”

The analysis, “Subcutaneous methylnaltrexone for opioid-induced constipation in advanced illness patients with or without active cancer,” was published online in Pain Management.

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