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

CancerNetwork® sat down with Andrew Cook, MD, at the 2021 American Society for Radiation Oncology to discuss outcomes with gabapentin compared with opioids for increasing quality of life and decreasing 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


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.


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

Related Videos
An expert from Dana-Farber Cancer Institute indicates that patients with prostate cancer who have 1 risk factor should undergo salvage radiotherapy following radical prostatectomy before their prostate-specific antigen level rises above 0.25 ng/ml.
An expert from Weill Cornell Medicine highlights key clinical data indicating the benefits of radium-223 in the treatment of patients with metastatic castration-resistant prostate cancer.
The risk of radionuclide exposure to the public reflects one reason urologists need to collaborate with radiation oncologists when administering radiopharmaceuticals to patients with prostate cancer.
Switching out beta emitters for alpha emitters, including radium-223, is one way to improve radiopharmaceutical treatment of prostate cancer, according to an expert from Weill Cornell Medicine.
Data demonstrate the feasibility of automated glomerular filtration rate prediction to decide between partial nephrectomy and radical nephrectomy in kidney cancer, according to an expert from the Cleveland Clinic.
Early phase trials investigating cellular therapies, bispecific antibodies, and antibody-drug conjugates for refractory kidney cancer may uncover strategies to overcome resistance mechanisms.
Increasing cancer antigen presentation as well as working with tumor cells in and delivering novel cells to the microenvironment may help in overcoming mechanisms of immune checkpoint inhibitor resistance in refractory renal cell carcinoma.
Lenvatinib plus pembrolizumab appears to be the best option for patients with refractory metastatic renal cell carcinoma who are progressing on immunotherapy combinations or are lenvatinib naïve.
Ipilimumab monotherapy does not appear effective in driving complete responses in refractory renal cell carcinoma despite yielding some progression-free survival intervals, according to an expert from the University of Texas Southwestern Medical Center.
An expert from the University of Texas Southwestern Medical Center discusses several phase 3 clinical trials supporting the use of various single-agent and combination immunotherapy regimens for advanced kidney cancer.