Abstract 293P
Background
OXN PR, a fixed dose combination of opioid and peripherally-acting mu-opioid antagonist, offers analgesia while reducing opioid-induced constipation (OIC). Few have studied OXN vs other strong opioids for impact on bowel function, safety and QoL in patients with CP.
Methods
Systematic review of literature from PubMed and EMBASE that evaluated analgesia, bowel function, adverse events (AE) and QoL after OXN PR or oral oxycodone (OXY)/morphine/tapentadol PR, or transdermal fentanyl, in adults with moderate-severe CP. Data for outcomes were extracted from publications or clinical study reports.
Results
4 RCTs (OXN vs OXY) were found; no RCT compared OXN vs other strong opioids. Analgesia and safety were comparable with OXN or OXY, except for nausea that was less frequent with OXN (Odds ratio: 0.51 [0.26, 0.97]). Most AEs related to OXN and OXY were mild-moderate severity; most common were gastrointestinal disorders. Improved bowel function (BFI, PAC-SYM) was observed with OXN vs OXY (Table). QoL was comparable with OXN or OXY (Global health status, mean difference: 0.5 [-4.7, 5.7]). Table: 293P
Descriptive findings for bowel function
RCTs | Findings | OXN vs OXY | |
BFI | |||
Scores over 4 weeks | 2 | Δ mean (% improvement)† | RCT 1: -25.1 (39.2%) vs -13.6 (21.7%) RCT 2: -36.0 (50.7%) vs -25.0 (36.8%) |
Score comparison at week 4 | 1 | LS mean difference (SE) | -11.1 (4.00) |
95% CI‡ | [-19.0, -3.2] | ||
P value‡ | 0.006 | ||
PAC-SYM | |||
Total score | 1 | Δ mean (% improvement)† | -7.0 (40.3%) vs -2.7 (15.1%) |
P-value§ | 0.0014 | ||
Symptom frequency | 1 | Δ mean (% improvement)† | -1.1 (41.9%) vs -0.3 (12.9%) |
P value§ | <0.001 |
†baseline to week 4 ‡adjusted for baseline using ANCOVA model. §between-group difference; derived from summary statistics LS, least squared.
Conclusions
Systematic review found only direct comparisons of OXN vs OXY in RCTs of CP. OXN provided similar analgesia and safety to OXY for CP with less nausea and improved bowel function, in terms of constipation symptoms. OXN is a valuable analgesic option in patients with OIC or nausea from cancer itself or anticancer treatment. Although limited, this meta-analysis confirms existing evidence on OXN’s efficacy and tolerability in patients with moderate-severe CP and highlights that few data on OXN in CP is available.
Clinical trial identification
Editorial acknowledgement
Editorial assistance was provided by Wei Yi Kwok and Geraldine Toh from Tech Observer Asia Pacific Pte Ltd.
Legal entity responsible for the study
Mundipharma Singapore Holding Pte Ltd.
Funding
Mundipharma Singapore Holding Pte Ltd.
Disclosure
S.H. Ahmedzai: Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution): Mundipharma. L. Langenhoven: Advisory/Consultancy, Speaker Bureau/Expert testimony: Mundipharma. C. Minnaert, Y. Hadjiat: Full/Part-time employment: Mundipharma. All other authors have declared no conflicts of interest.
Resources from the same session
133P - Which patient subgroup needs more attention in early treatment failure? A matched cohort study of treatment failure patterns in locally advanced gastric cancer
Presenter: Dong Wu
Session: e-Poster Display Session
134P - Effect of preoperative tumour under-staging on the long-term survival of patients undergoing radical gastrectomy for gastric cancer
Presenter: Mi Lin
Session: e-Poster Display Session
135P - Significance of lymphatic invasion in the indication for additional gastrectomy after endoscopic treatment
Presenter: Hirohito Fujikawa
Session: e-Poster Display Session
136P - Modified ypTNM staging classification for gastric cancer after neoadjuvant therapy: A multi-institutional study
Presenter: Wen-Wu Qiu
Session: e-Poster Display Session
137P - Clinical utility of circulating tumour DNA (ctDNA) in resectable gastric cancer (GC)
Presenter: Mikhail Fedyanin
Session: e-Poster Display Session
138P - Prognostic importance of dynamic changes in systemic inflammatory markers for patients with gastric cancer
Presenter: Ying-Qi Huang
Session: e-Poster Display Session
139P - An intraoperative model for predicting survival and deciding therapeutic schedules: A comprehensive analysis of peritoneal metastasis in patients with advanced gastric cancer
Presenter: Zhi-Yu Liu
Session: e-Poster Display Session
140P - Preoperative and postoperative C-reactive protein levels predict recurrence and chemotherapy benefit in gastric cancer
Presenter: Li-Li Shen
Session: e-Poster Display Session
141P - Low expression of CDK5RAP3 and UFM1 indicates poor prognosis in patients with gastric cancer
Presenter: Ning-Zi Lian
Session: e-Poster Display Session
142P - Prognostic analysis of patients with intra-abdominal infectious complications after laparoscopy and open radical gastrectomy for gastric cancer: A propensity score-matching analysis
Presenter: Si-Jin Que
Session: e-Poster Display Session