GREAT - Good Response With Appropriate Treatment

Mario Negri Institute for Pharmacological Research200 enrolled

Overview

The symptoms associated in advanced cancer patients and adverse events due to use of opioids have major influence on the state of health and quality of life of patients. The pain, in particular, is a symptom with severe negative impact and with a prevalence ranging between 33% and 64%, according to the stage of the disease, with values around 70-90% in advanced stages and metastatic. The use of opioids, however, is usually associated with the appearance of common adverse events as drowsiness/sedation, constipation, nausea/vomiting, and dizziness. Some effects are self-limiting in the time for the appearance of tolerance while others, as constipation persist. Several clinical studies have demonstrated that the association oxycodone-naloxone (OXN), which consists in the union between a molecule agonist and an antagonist of opioid receptors, reduced the constipation in the presence of unchanged analgesic efficacy compared to oxycodone alone.

Study Type

OBSERVATIONAL

Enrollment

200

Conditions

Cancer Pain Neoplasms

Interventions

Oxycodone-Naloxone

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Patients with diagnostic (histological or cytological) evidence of locally advanced or metastatic solid tumour; * With average pain intensity \> 4, measured with NRS and related to the last 24 hours, due to the cancer, requiring OXN for the first time; * With life expectancy \> one month; * Strong opioid naïve; * Eligible to take any of the medications under evaluation; * With age ≥ 18 years. Exclusion Criteria: * With presence of other diseases, including psychiatric/mental illness, severe senile or other form of dementia, that can interfere with participation and compliance with the study protocol or can contraindicate the use of the investigational drugs; * Diagnosis of primary brain tumor or leukaemia; * Diagnosis of chronic renal failure; * Patients with antalgic radiotherapy or radio-metabolic therapy in progress or completed less than 14 days before study; * Patients starting a first line chemotherapy simultaneously to the beginning of the study; * Other types of analgesic treatments, including local-regional anesthetic techniques or neurosurgical /ablative methods; * Patients who cannot guarantee regular follow-up visits for logistic or geographic reasons.

Locations (18)

Ospedale degli Infermi di Biella

Biella, Biella, Italy

IRCCS Centro di Riferimento Oncologico di Aviano

Aviano, Italy

Ospedale Oncologico A. Businco

Cagliari, Italy

E.O. Ospedali Galliera Genova

Genova, Italy

Presidio Ospedaliero di Macerata

Macerata, Italy

IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico di Milano

Milan, Italy

Istituto Scientifico San Raffaele

Milan, Italy

Ospedale di Mirano

Mirano, Italy

Ospedale V. Monaldi

Napoli, Italy

IRCCS Istituto Oncologico Veneto

Padua, Italy

...and 8 more locations

Outcomes

Primary Outcomes

non responders

Subjects will be classified as non-responders (NR) to treatment if between from the first and to last visit during the follow-up will not exhibit a reduction in average pain at least 30% and/or do not reach a final score of ≤ 4 pain points, defined as average pain experienced in the last 24 hours and measured by an 11-point numerical scale from 0 (no pain) to 10 (maximum pain imaginable).

Time frame: 28 days

Secondary Outcomes

Opioids Escalation Index

Percentage of subjects that will need during the follow-up an increase in daily opioid dose ≥5%, measured by the OEI% (Opioids Escalation Index). The value of 5% identifies the cut-off between the increases of dose considered normal or high entity.

Time frame: 28 days

additional opioid treatment

Proportion of subjects that will need during the follow-up of an action to "additional" opioid treatment, in addition to the basic treatment programmed, to maintain the analgesic response in the treatment "around the clock".

Time frame: 28 days