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Intrathecal Bolus Trials of Ziconotide for Cancer-Related Pain

Intrathecal Bolus Trials of Ziconotide for Cancer-Related Pain. Mitchell Engle M.D., Ph.D. Obinna Uzodinma , M.D. Brian Bruel , M.D., M.B.A MD Anderson Cancer Center Houston, TX. Disclosures. ME None OU None BB Consultant for Jazz Pharmaceuticals Consultant for Medtronic.

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Intrathecal Bolus Trials of Ziconotide for Cancer-Related Pain

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  1. Intrathecal Bolus Trials of Ziconotide for Cancer-Related Pain Mitchell Engle M.D., Ph.D. ObinnaUzodinma, M.D. Brian Bruel, M.D., M.B.A MD Anderson Cancer Center Houston, TX

  2. Disclosures • ME • None • OU • None • BB • Consultant for Jazz Pharmaceuticals • Consultant for Medtronic

  3. Ziconotide • Synthetic selective N-type Calcium Channel blocker • Problem: Poor pain control in cancer patients despite high dose opioid and adjuvant medications • Objective: Demonstrate that single shot intrathecal trials of ziconotide effectively reduce cancer related pain

  4. Study Design • Retrospective chart review • Three year time period (2009-2012) • Single shot bolus trials of ziconotide • Both mono- and combination trials • Pre-trial and 24 hr post-procedure numeric pain scores • Successful trial: > 30% numeric pain score reduction • Etiology of pain was tumor or cancer related treatments

  5. Demographic Data • 40 individual patients • 44 independent trials Tumor Related 27 Treatment Related 14 Other 3

  6. Ziconotide Doses Mean (mcg) 2.6 2.5 2.7 N 40 30 10

  7. Combination Effects Successful Trials Failed Trials Ziconotide alone +Bupivacaine Ziconotide alone +Bupivacaine Zicono (mcg) 2.8 2.5 2.8 2.6 Bupiv (mg) 2.2 1.8 N 12 16 5 5

  8. Dose Distribution

  9. Diagnoses of Successful Trials Metastatic Disease 10 Metastasis to Spine 10 3 Post-laminectomy Pain 2 Locally Advanced Disease 1 CIPN 1 Compression Fractures 3 Other

  10. Conclusions • Single shot intrathecalziconotide produces robust analgesia in cancer pain patients • The average dose of ziconotide for successful trials was approximately 2.5 mcg • Bupivacaine did not appear to produce an additive or synergistic effect for ziconotide • Ziconotide successfully produced analgesia in patients with metastatic cancer pain, chronic post-surgical pain, and CIPN.

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