Analgesic effectiveness and tolerability of oral oxycodone/naloxone and pregabalin in patients with lung cancer and neuropathic pain: an observational analysis

Abstract

Introduction: Cancer-related pain has a severe negative impact on quality of life. Combination analgesic therapy with oxycodone and pregabalin is effective for treating neuropathic cancer pain. We investigated the efficacy and tolerability of a dose-escalation combination therapy with prolonged-release oxycodone/naloxone (OXN-PR) and pregabalin in patients with non-small-cell lung cancer and severe neuropathic pain.

Methods: This was a 4-week, open-label, observational study. Patients were treated with OXN-PR and pregabalin. Average pain intensity ([API] measured on a 0-10 numerical rating scale) and neuropathic pain (Douleur Neuropathique 4) were assessed at study entry and at follow-up visits. The primary endpoint was response to treatment, defined as a reduction of API at T28 ≥30% from baseline. Secondary endpoints included other efficacy measures, as well as patient satisfaction and quality of life (Brief Pain Inventory Short Form), Hospital Anxiety and Depression Scale, and Symptom Distress Scale; bowel function was also assessed.

Results: A total of 56 patients were enrolled. API at baseline was 8.0±0.9, and decreased after 4 weeks by 48% (4.2±1.9; P<0.0001 vs baseline); 46 (82.1%) patients responded to treatment. Significant improvements were also reported in number/severity of breakthrough cancer pain episodes (P=0.001), Brief Pain Inventory Short Form (P=0.0002), Symptom Distress Scale (P<0.0001), Hospital Anxiety and Depression Scale depression (P=0.0006) and anxiety (P<0.0001) subscales, and bowel function (P=0.0003). At study end, 37 (66.0%) patients were satisfied/very satisfied with the new analgesic treatment. Combination therapy had a good safety profile.

Conclusion: OXN-PR and pregabalin were safe and highly effective in a real-world setting of severe neuropathic cancer pain, with a high rate of satisfaction, without interference on bowel function.

Keywords: breakthrough cancer pain; neuropathic cancer pain; non-small-cell lung cancer; opioids; oxycodone/naloxone; pregabalin.

Figure1

Patient disposition and response rate after oxycodone/naloxone and pregabalin. Note: Response, >30% pain intensity reduction between the first visit and the last visit. Abbreviation: NSCLC, non-small-cell lung cancer.

Figure 2

API score (11-point NRS) throughout the observation. Note: *P<0.001 versus result at previous time point. Abbreviations: API, average pain intensity; NRS, numerical rating scale.

Figure 3

Waterfall image of individual percentage changes from baseline in pain intensity score (numeric rating scale) among the 56 patients who completed the observation. Notes: Mean pain intensity decrease at study end was 47.6%±24.3% (median −50%, range +14%, −100%). Green bars indicate responders.

Figure 4

Proportions and numbers of patients with severe (NRS 7–10), moderate (NRS 4–6), or mild (NRS 1–3) average pain intensity, or no pain at all (NRS 0) during the 28-day observation with OXN-PR and pregabalin. Note: Six patients still complained of severe pain (NRS >6) after 28 days. Abbreviations: NRS, numeric rating scale; OXN-PR, prolonged-release oxycodone/naloxone.