European Journal of Pain Supplements 1 (2007) 96–97

www.EuropeanJournalPain.com

Poster

A case of recurrent breast cancer suggesting chemotherapy affected the

pain control with oxycodone
Daisuke Inoue *, Kazumi Hayashi, Yasuhiro Arakawa, Junichi Mohri, Tadashi Kobayashi,
Keisuke Aiba
Department of Oncology and Hematology, The Jikei University School of Medicine, Tokyo, Japan

1. Case and course

Patient: A 41-year-old woman.

Course:
• June: Noticed a mass in the right breast and next month
we underwent radical surgery. Right Breast cancer
at the initial examination was T2N0M0 (Stage IIa,
Intermediate risk, Estrogen receptor −, Hercep test 3+)
• October to January, next year: Received the 5-
fluorouracil, epirubicin, and cyclophosphamide (FEC-
100) regimen
• February, next year: Received radiotherapy (5 weeks)
• October, next year: Admitted to hospital because of
abdominal distension, abdominal pain (right hypochon-
drium), ascites, and jaundice due to liver metastasis that
CT revealed.
Fig. 1. Course (1).

2. Course of pain control
Her symptoms repeatedly worsened or abated and pain
control with oxycodone at a dose of 5 to 40 mg/day
also yielded unstable results. Her demands for oxycodone
were consistent with waist measurement and liver function
following various chemotherapy regimens. After admission,
first-line therapy with paclitaxel and Trastuzumab was
initiated at the patient’s demand, although treatment with
taxane agents was contraindicated because of the increased
T-Bil level. Ascites and AST, ALT, and T-Bil levels
temporarily improved, but chemotherapy was discontinued
due to infusion reactions (pyrexia and rash). First-line
therapy was switched to combination chemotherapy with
vinorelbine and trastuzumab (Burstein, 2001), which was
terminated because of pyrexia and increases in AST and
ALT levels. Then Vinorelbine was changed to capecitabine
and continued untill seven month of hospitalization when
we decided on discharge. The course was presented in
Figs. 1–3.
Conclusion
The symptoms following chemotherapy, such as pyrexia,
ascites, and others, often adversely affected the dosage
of oxycodone, suggesting that chemotherapy might have
influence on the pain control with oxycodone.

* Correspondence to: Daisuke Inoue, Department of Oncology and

Hematology, The Jikei University School of Medicine, Tokyo, Japan.

1754-3207/$32 © 2007 European Federation of Chapters of the International Association for the Study of Pain. Published by Elsevier Ltd. All rights
reserved.
 D. Inoue et al. / European Journal of Pain Supplements 1 (2007) 96–97 97

Fig. 3. Course (3).

Fig. 2. Course (2).

Reference

Burstein HJ. Clinical Activity of Trastuzumab and Vinorelbine in Women

With HER2-Overexpressing Metastatic Breast Cancer. J Clin Oncol-
ogy 2001;15:2722–2730.