Gabapentin for the prevention of chemotherapy- induced nausea and vomiting: a pilot study

Cruz, Felipe Melo; Cubero, Daniel de Iracema Gomes; Taranto, Patrícia; Lerner, Tatiana Goberstein; Lera, Andrea Thaumaturgo; Miranda, Michele da Costa; Vieira, Marcelo de Andrade; Fêde, Ângelo Bezerra de Souza; Schindler, Fernanda; Carrasco, Mércia Maleckas; Afonseca, Samuel Oliveira de; Pinczowski, Hélio; Giglio, Auro del

doi:10.1007/s00520-011-1138-4

Cited by 46 publications

(20 citation statements)

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“…Several studies involving treatment of neuropathic cancer pain found gabapentin to be the most commonly prescribed adjuvant [24, [66][67][68][69][70][71]. Gabapentin is also effective in a multitude of other symptoms including insomnia [72][73][74], cough [75][76][77], hiccough [78][79][80], nausea [81][82][83], and delirium [84]. The use of steroids may be for multiple reasons, i.e., as an adjuvant but also for non-pain symptoms such as fatigue and anorexia [85,86].…”

Section: Discussionmentioning

confidence: 99%

Use of non-opioid analgesics as adjuvants to opioid analgesia for cancer pain management in an inpatient palliative unit: does this improve pain control and reduce opioid requirements?

Shinde

Gordon

Sharma

et al. 2014

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Background Cancer pain is complex, and despite the introduction of the WHO cancer pain ladder, few studies have looked at the prevalence of adjuvant medication use in an inpatient palliative medicine unit. In this study, we evaluate the use of adjuvant pain medications in patients admitted to an inpatient palliative care unit and whether their use affects pain scores or opiate dosing. Methods In this retrospective observational study, patients admitted to the inpatient palliative care unit over a 3-month period with a diagnosis of cancer on opioid therapy were selected. Data pertaining to demographics, diagnosis, oral morphine dose equivalent of the opioid at the time of discharge, adjuvant analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), and pain scores as reported by nurses and physicians were collected. Results Seventy-seven patients were eligible over a 3-month period, out of which 65 (84 %) were taking an adjuvant medication. The most commonly prescribed adjuvant was gabapentin (70 %). Fifty-seven percent were taking more than one adjuvant. There were more women in the group receiving adjuvants (57 vs. 17%, p=0.010). Those without adjuvants compared with those on adjuvants did not have worse pain scores on discharge as reported by physicians (0.8±0.8 vs. 1.0±0.7, p=0.58) or nurses (2.0±2.7 vs. 2.1±2.6, p=0.86). There was no difference in morphine equivalent doses of the opioid in both groups (median (min, max); 112 (58, 504) vs. 200 (30, 5,040)) at the time of discharge; 75-80 % of patients had improvement in pain scores as measured by a two-point reduction in numerical rating scale (NRS). Discussion This study shows that adjuvant medications are commonly used for treating pain in patients with cancer. More than half of study population were on two adjuvants or an adjuvant plus NSAID along with an opioid. We did not demonstrate any benefit in terms of improved pain scores or opioid doses with adjuvants, but this could reflect confounding variables and physician choice. Larger prospective studies are needed to define the opioid-sparing effects of adjuvants. Conclusion Adjuvant agents are used in over 80 % of those treated for cancer pain.

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Section: Discussionmentioning

confidence: 99%

Use of non-opioid analgesics as adjuvants to opioid analgesia for cancer pain management in an inpatient palliative unit: does this improve pain control and reduce opioid requirements?

Shinde

Gordon

Sharma

et al. 2014

Support Care Cancer

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“…We need better tools to stratify a patient's CINV risk based on validated predictive tools [33,34] to optimize care (NCT01913990). Clinical trials of more affordable, generic drugs, specifically olanzapine but also gabapentin, have shown some promising data and might offer better control of CINV without the need for more expensive, newer agents [35,36]. Drugs that were recommended in the older guidelines [15] such as metoclopramide show some benefit compared with 5-HT3 antagonists in the delayed period when given with dexamethasone but have fallen to the wayside because of a low risk of extrapyramidal side effects [37].…”

Section: Wwwtheoncologistcom ©Alphamed Press 2015mentioning

confidence: 99%

Chemotherapy-Induced Nausea and Vomiting: Time for More Emphasis on Nausea?

Hutton

Clemons

2015

The Oncologist

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Despite advances in antiemetic therapy, chemotherapyinduced nausea and vomiting (CINV) remains the most feared and expected side effect of chemotherapy [1]. Optimization of antiemetic therapy is important because CINV can lead to reduced quality of life, increased use of health care resources, and compromised treatment adherence. The combination of anthracycline and cyclophosphamide is used extensively in breast cancer patients and traditionally has been classified as being moderately emetogenic [2]. However, in 2011, the American Society of Clinical Oncology reclassified the combination of an anthracycline with cyclophosphamide as highly emetogenic, given its propensity to induce CINV, particularly nausea, in breast cancer patients [3]. Since then, local [4], national [3, 5], and international [6] antiemetic guidelines have emphasized the use of aprepitant in combination with 5-hydroxytryptamine-3 (5-HT3) antagonists and corticosteroids in this population. Not surprisingly, aprepitant-containing regimens have become the standard recommendation at many institutions, and aprepitant use has soared. Has this optimism from both patients and physicians significantly improved patient care?Despite the significant improvements in CINV reported in the aprepitant trials, control of CINV-and nausea in particular-remains suboptimal in patients receiving anthracycline and cyclophosphamide-based regimens [7,8]. In the nontrial setting, ∼58%-71% of patients will have nausea and/or vomiting despite "optimal" antiemetic prescribing (C. Hernandez-Torres, personal communication) [9]. What is the cause of this discrepancy? It is likely a combination of factors including health care staff underestimating the incidence of CINV [10], suboptimal adherence to antiemetic guidelines [9], lack of an optimal antiemetic regimen [11], clinical trials overestimating the benefit of antiemetics [7], and, quite simply, current trial endpoints that do not fully reflect patient experience. We feel this is an opportune moment to review the evidence to illustrate how antiemetic recommendations have evolved andtoraise ongoing issues and controversies in the management of CINV, especially in the breast cancer population.As all oncologists are aware, there has been significant progress in CINV control. Historically, antiemetic regimens were developed using cisplatin (.50 mg/m 2 ) as the benchmark because it causes CINV in almost all patients not receiving antiemetic prophylaxis. Based on the proposed pathophysiology of CINV, control of emesis has also been divided into acute (0-24 hours), delayed (.24-120 hours), and overall (0-120 hours) periods following chemotherapy [12], with antiemetic combinations being specifically chosen depending on their efficacy during these different time points. Following the results from antiemetic trials for patients receiving cisplatin-based chemotherapy (Table 1), most current antiemetic guidelines recommend a three-drug regimen consisting of aprepitant (days 1-3), 5-HT3 receptor antagonist (day 1), and dexamethasone (d...

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“…At our institution, Cruz et al conducted a prospective, double-blinded, placebo-controlled study that showed that adding gabapentin to the standard preventive antiemetic treatment for moderately and highly emetogenic chemotherapy was effective (65% vs. 42.5%; P = 0.04). 16 Their trial demonstrated that the acute complete control rate and use of gabapentin were independent factors for achieving an overall complete response.…”

Section: Discussionmentioning

confidence: 99%

“…Cruz et al 16 at our institution, which resulted in a 42.5% control rate in the placebo group, we used a control rate < 50% as the null hypothesis to be tested and a rate > 70% as the alternative hypothesis, since the previous trial showed a 20% benefit from associating gabapentin. The initial end point to be pursued was full control for a minimum of 9 patients out of the 15 in the first stage of the study.…”

Section: Methodsmentioning

confidence: 99%

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Carbamazepine for prevention of chemotherapy-induced nausea and vomiting: a pilot study

et al. 2014

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CONTEXT AND OBJECTIVE: Nausea and vomiting are major inconveniences for patients undergoing chemotherapy. Despite standard preventive treatment, chemotherapy-induced nausea and vomiting (CINV) still occurs in approximately 50% of these patients. In an attempt to optimize this treatment, we evaluated the possible effects of carbamazepine for prevention of CINV. DESIGN AND LOCATION:Prospective nonrandomized open-label phase II study carried out at a Brazilian public oncology service. METHODS:Patients allocated for their first cycle of highly emetogenic chemotherapy were continuously recruited. In addition to standard antiemetic protocol that was made available, they received carbamazepine orally, with staggered doses, from the third day before until the fifth day after chemotherapy. Considering the sparseness of evidence about the efficacy of anticonvulsants for CINV prevention, we used Simon's two-stage design, in which 43 patients should be included unless overall complete prevention was not achieved in 9 out of the first 15 entries. The Functional Living Index-Emesis questionnaire was used to measure the impact on quality of life. RESULTS: None of the ten patients (0%) presented overall complete prevention. In three cases, carbamazepine therapy was withdrawn because of somnolence and vomiting before chemotherapy. Seven were able to take the medication for the entire period and none were responsive, so the study was closed. There was no impact on the patients' quality of life. CONCLUSION: Carbamazepine was not effective for prevention of CINV and also had a deleterious sideeffect profile in this population. CLINICAL TRIAL REGISTRATION: NCT01581918.RESUMO CONTEXTO E OBJETIVO: Náusea e vômito são inconvenientes importantes para pacientes submetidos a quimioterapia. A despeito do tratamento preventivo padrão, náuseas e vômitos induzidos por quimioterapia (NVIQ) ocorrem em aproximadamente 50% dos pacientes. Na tentativa de otimizar este tratamento, avaliamos os possíveis efeitos da carbamazepina na prevenção de náuseas e vômitos induzidos por quimioterapia. TIPO DE ESTUDO E LOCAL: Estudo fase II, prospectivo, não randomizado, aberto, realizado em um serviço público brasileiro de oncologia. MÉTODOS: Recrutaram-se continuamente pacientes alocados para o primeiro ciclo de quimioterapia altamente emetogênica. Além do protocolo anti-emético padrão disponibilizado, os pacientes receberam carbamazepina, por via oral, em doses escalonadas, a partir do terceiro dia anterior até o quinto dia após a quimioterapia. Dada a escassa evidência de eficácia dos anticonvulsivantes na prevenção de NVIQ, adotamos o desenho de Simon em duas fases, que deveria incluir 43 pacientes a não ser que prevenção completa global não fosse alcançada em 9 dos primeiros 15 participantes. O questionário "Functional Living Index-Emesis" foi usado para avaliar o impacto na qualidade da vida. RESULTADOS: Nenhum dos 10 pacientes (0%) apresentou prevenção completa global. Três tiveram a carbamazepina suspensa por sonolência e vômito antes da quimio...

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Gabapentin for the prevention of chemotherapy- induced nausea and vomiting: a pilot study

Abstract: Gabapentin is a low-cost strategy to improve complete control of CINV, specially delayed CINV control.

Cited by 46 publications

References 28 publications

Use of non-opioid analgesics as adjuvants to opioid analgesia for cancer pain management in an inpatient palliative unit: does this improve pain control and reduce opioid requirements?

Use of non-opioid analgesics as adjuvants to opioid analgesia for cancer pain management in an inpatient palliative unit: does this improve pain control and reduce opioid requirements?

Chemotherapy-Induced Nausea and Vomiting: Time for More Emphasis on Nausea?

Carbamazepine for prevention of chemotherapy-induced nausea and vomiting: a pilot study

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