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Methadone as anticancer treatment: hype, hope, or hazard? - Wiener Medizinische Wochenschrift

  • ️Nauck, Friedemann
  • ️Mon Feb 19 2018

Summary

Recently, the use of methadone in cancer patients has increased due to in vitro studies indicating that methadone is capable of inducing cell death. However, thus far there are no relevant clinical studies indicating that the use of methadone can prolong survival in cancer patients. Based on low-quality evidence, methadone is a drug that has similar analgesic benefits to morphine and has a role in the management of cancer pain in adults. Other opioids such as morphine, hydromorphone, and fentanyl are easier to manage but may be more expensive than methadone in many economies. Methadone is an opioid that is only approved for replacement therapy in Austria. Methadone can be used as a second- or third-line agent for severe cancer-related pain, but its use should be restricted to experts. Here we report a series of cases of patients who developed problems when using methadone as an antitumor treatment, with a brief review on the role of methadone as a pain medication and the current lack of value as an anti-tumor therapy. Methadone is not approved or recommended as an anticancer treatment in Austria or Germany. The Austrian Association for Hemato-oncology (OeGHO), the Austrian Association for the Management of Pain (ÖSG), and the Austrian Association for Palliative Care (OPG) do not recommend the use of methadone as an anticancer treatment. Thus, from a medical and ethical point of view, the use of methadone as an antitumor therapy is to be rejected, based on the views of various Austrian (OeGHO, ÖSG, OPG) and German specialists. Unqualified use of methadone by nonexperienced pain therapists is dangerous and must also be rejected.

Zusammenfassung

In letzter Zeit hat die Verwendung von Methadon bei Krebspatienten zugenommen, weil Daten zeigten, dass Methadon in vitro in der Lage ist, den Zelltod zu induzieren. Bisher gibt es jedoch keine relevanten klinischen Studien, die darauf hinweisen, dass die Verwendung von Methadon das Überleben bei Krebspatienten verlängern kann oder das Tumorwachstum zurückdrängt. Gemäß Nachweisen von geringer Qualität ist Methadon eine Substanz, die einen ähnlichen analgetischen Nutzen wie Morphin hat und zur Linderung von Tumorschmerzen bei Erwachsenen eingesetzt wird. Andere Opioide wie Morphin, Hydromorphon und Fentanyl sind leichter zu handhaben, aber möglicherweise in vielen Wirtschaftssystemen teurer als Methadon. Methadon ist ein Opioid, welches in Österreich lediglich zur Substitutionstherapie zugelassen ist. Von sehr erfahrenen Schmerztherapeuten kann es als Schmerzmittel eingesetzt werden, wenn die Wirkung anderer Opioide nicht ausreicht. Anbei ergänzen die Autoren eine Reihe von Fallberichten von Patienten, die unter erheblichen Nebenwirkungen von Methadon, welches bei ihnen als Antitumormittel eingesetzt wurde, mit einem kurzen Review über den Stellenwert von Methadon als Schmerzmittel und den derzeit nicht vorhandenen Stellenwert als Antitumortherapie. Methadon ist in Österreich oder Deutschland nicht als Antitumortherapie zugelassen oder empfohlen. Die Österreichische Gesellschaft für Hämatoonkologie, die Österreichische Gesellschaft für Schmerzbehandlung und die Österreichische Gesellschaft für Palliative Care sprechen sich gegen die Anwendung von Methadon als Antitumortherapie aus. Aus medizinischer und ethischer Sicht ist daher die Anwendung von Methadon als Antitumortherapie nach Ansicht verschiedener österreichischer (OeGHO, ÖSG, OPG) und deutscher Spezialisten abzulehnen. Die unqualifizierte Verwendung von Methadon durch unerfahrene Ärzte ist gefährlich und muss ebenfalls abgelehnt werden.

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Author information

Authors and Affiliations

  1. Division of Palliative Care, Department of Internal Medicine 2, University Hospital, Karl Landsteiner University of Health Sciences, Mitterweg 10, 3500, Krems an der Donau, Austria

    Gudrun Kreye & Beate Stich

  2. Division of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Waehringer Guertel 18–20, 1090, Vienna, Austria

    Eva-Katharina Masel

  3. Department of Pneumonology, Krems University Hospital, Krems, Austria., Karl Landsteiner University of Health Sciences, Krems, Austria

    Klaus Hackner

  4. Abteilung Palliativmedizin, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany

    Friedemann Nauck

Authors

  1. Gudrun Kreye

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  2. Eva-Katharina Masel

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  3. Klaus Hackner

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  4. Beate Stich

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  5. Friedemann Nauck

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Corresponding author

Correspondence to Gudrun Kreye.

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Conflict of interest

G. Kreye, E.-K. Masel, K. Hackner, B. Stich, and F. Nauck declare that they have no competing interests.

Ethical standards

This article does not contain any studies with human participants or animals performed by any of the authors. Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

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Kreye, G., Masel, EK., Hackner, K. et al. Methadone as anticancer treatment: hype, hope, or hazard?. Wien Med Wochenschr 168, 159–167 (2018). https://doi.org/10.1007/s10354-018-0623-5

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  • Received: 01 November 2017

  • Accepted: 25 January 2018

  • Published: 19 February 2018

  • Issue Date: May 2018

  • DOI: https://doi.org/10.1007/s10354-018-0623-5

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