Andrew Cook, MD, Discussed the Rational for Using Gabapentin to Prevent CRT-Related Pain in Oropharyngeal Cancer

At the 2021 American Society for Radiation Oncology, CancerNetwork® spoke with Andrew Cook, MD, a resident at Henry Ford Health System, about the rationale behind utilizing prophylactic gabapentin (Neurontin) instead of traditional opioids to reduce therapy-induced pain in patients with oropharyngeal cancer. In a trial assessing the prophylactic treatment, Cook explained that their focus was to limit opioid use to try and provide benefit within a curative intent patient population.

Transcript:

In general treating patients with head and neck cancer, mucositis is a very common [adverse] effect. It’s very difficult to manage. We’re [fairly] limited in our techniques that we can use for that in terms of lifestyle modifications, oral anesthetic mouth rinses, and opioid medications. A vast majority of these patients are undergoing curative intent therapy, and looking at rates of opioid use, many studies quoted patients being on these opioid medications, with up to 40% of them buying [opioids] 3 months out and 20% 6 months out. Clearly, limiting opioid use in a curative intent population is something that is a priority and will be beneficial for these patients.

Gabapentin has been one strategy that a lot of practitioners have been using. It has been looked at before in some studies, although the outcomes of those overall have been mixed on whether it’s helpful. In addition to thinking specifically about the prospective studies that have looked at this, none of them had used a placebo comparator. They all use a broad range of patients. Some patients [who] underwent post-operative radiation therapy vs definitiveradiotherapy [received] different radiation doses and chemotherapy at different subsites. What we wanted to do was look at this question using a placebo comparator with a very select group of patients, namely locally advanced oropharyngeal squamous cell carcinoma [who were] undergoing definitive chemoradiotherapy.

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