Andrew Cook, MD, Discussed Outcomes with Gabapentin vs Opioids to Prevent Treatment-Related Pain in Oropharyngeal Cancer

At the 2021 American Society for Radiation Oncology, CancerNetwork® spoke with Andrew Cook, MD, a resident from Henry Ford Health System, how well gabapentin (Neurontin) reduced treatment-related pain and bolstered quality of life compared with opioids. Notably, gabapentin did not prove to be an effective strategy for improving pain or quality of life within this patient population. Cook also noted that feeding tube placement in the gabapentin arm was significantly higher compared with the opioid arm

Transcript:

Overall, this was a negative study. Our primary end point looked at patient-reported oral mucositis symptom scale scores, also known as the PROMS scale. Specifically, the difference in scores between follow-up and baseline was our primary end point. There was no significant difference between the arms in terms of that. We also looked at quality of life metrics, specifically FACT-HN and PRO-CTCAE scores. One of the subscales in the FACT-HN questionnaire as well as the PRO-CTCAE form [was] those patients, we noted, had a significantly worse quality of life. When we looked at opioid use [and] we looked at a few different ways, but overall there was no difference in opioid use between the 2 arms.

The most surprising finding in our study was that feeding tube placement was significantly higher in the gabapentin arm compared with the placebo arm—[62.1%] compared with [20.7%], which is quite a big difference from that standpoint. One of the things we considered was that gabapentin can work synergistically with opioids and contribute to poor feeding and somnolence that might contribute to feeding tube placement. One of the things I didn’t mention was that weight loss was no different between the 2 arms. The main thing is to remind people that this was a double blinded, placebo-controlled study, so it takes out that bias from the study design, and it was very surprising to see that.

Reference

Cook AE, Modh A, Ali H, et al. Randomized phase III, double-blind, placebo-controlled study of prophylactic gabapentin for the reduction of radiation therapy-induced pain during the treatment of oropharyngeal squamous cell carcinoma. Int J Radiat Oncol Biol Phys. 2021; 111 (suppl 3): S61-S62. doi:10.1016/j.ijrobp.2021.07.156