The background infusion may matter in IV PCA for cancer pain

The edition in brief

The edition closes on a Chinese multicentre trial in 226 patients with refractory cancer pain on intravenous hydromorphone patient-controlled analgesia. Bolus-only dosing gave 72-hour pain relief in 89.4% against 94.2% with a background infusion, and failed to show non-inferiority, while adverse events were similar. For patients sick enough to need IV PCA, keeping a continuous background dose is the safer default. In MASTERPLAN, a phase 2 trial in 74 people with high-risk localised pancreatic cancer, adding stereotactic body radiotherapy to chemotherapy cut 12-month locoregional recurrence from 52% to 20% (subdistribution HR 0.44) without significantly more severe toxicity; the trial closed early and is not yet practice-changing. NANT, a single-arm phase 2 trial in 67 Chinese women with HRD-positive advanced ovarian cancer unsuitable for primary surgery, reported a 63% response to two cycles of neoadjuvant niraparib and R0 resection in 80% of those operated, with grade 3-4 thrombocytopenia in 48%. A 46-patient trial suggested oral N-acetylcysteine before each oxaliplatin dose reduced neuropathy scores. The pearl covers the first hour of febrile neutropenia.