Oncology (General Cancer)/Drug Interaction

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Question
QUESTION: My 84 year old mother is suffering from lung cancer,but is remaining fine on Gefitinib.No cough/breathing trouble/wheezing etc.But recently she is suffering from severe shoulder pain.Ultrasonography has revealed bicep tendinitis in shoulder.Pain management Specialist wants to give steroid injection.I wish to know whether the steroid will have any adverse drug interaction with Gefitinib.

ANSWER: No.  Have her take the steroid injection by all means.  I know of no interaction between the two drugs that would be detrimental to the anti-cancer effect of gefitinib.  

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QUESTION: Actually initially Pain Management Specialist has given her Buprenorphine Trasnsdermal Patch(10).If necessary Steroid Injection will be given.I would like to know from you considering her cancer whether the Patch or Steroid injection will be a better option.Please help.

Answer
Buprenorphine is a strong narcotic, and may have adverse effects on an 84 year old's mind.  That isn't to say it is not worth trying.  However, before giving a patch, I'd want to use a short-acting narcotic like hydrocodone or oxycodone, and titrate until she was out of pain and not showing adverse effects.  Then I'd calculate the equivalent dose of the buprenorphine patch.  However, I really would try the steroid injection before going to a narcotic regimen.  If it works, you might not need narcotics; and there isn't very much in the way of a downside.  If it doesn't work, you've got the narcotics to fall back on.  

Oncology (General Cancer)

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Donald Higby, M.D.

Expertise

I can answer almost all questions related to the treatment and natural course of most kinds of cancer, especially cancers of prostate, colon, lung and breast.

Experience

I have been a practicing medical oncologist for 36 years, and have been chief of service at a major medical center for 25 years. I've also done research in cancer treatments.

Organizations
American Society of Clinical Oncology

Publications
New England Journal of Medicine American Journal of Medicine Journal of the American Society of Clinical Oncology Hematology Transfusion Medicine

Education/Credentials
MD, Stanford University Internal Medicine residency, St. Louis University School of Medicine, St. Louis, MO Medical Oncology Fellowship, Roswell Park Cancer Institute, Buffalo, NY

Awards and Honors
America's Best Physicians, last 14 years

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