Intrathecal bolus trials of ziconotide for cancer related pain
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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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Intrathecal bolus trials of ziconotide for cancer related pain

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


Disclosures

Disclosures

  • ME

    • None

  • OU

    • None

  • BB

    • Consultant for Jazz Pharmaceuticals

    • Consultant for Medtronic


Ziconotide

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


Study design

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


Demographic data

Demographic Data

  • 40 individual patients

    • 44 independent trials

Tumor Related

27

Treatment Related

14

Other

3


Ziconotide doses

Ziconotide Doses

Mean (mcg)

2.6

2.5

2.7

N

40

30

10


Combination effects

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


Dose distribution

Dose Distribution


Diagnoses of successful trials

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


Conclusions

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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