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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
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
• 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
• 40 individual patients
– 44 independent trials
Tumor Related
27
Treatment Related
Other
14
3
40 Patients
30 Successful
Trials (75%)
10 Failed Trials
1 Successful
Retrial
3 Failed
Retrials
(25%)
Ziconotide Doses
Mean (mcg) 2.6
2.5
2.7
N
30
10
40
Combination Effects
+Bupivacaine
Ziconotide alone
+Bupivacaine
Zicono (mcg)
Bupiv (mg)
N
Failed Trials
Ziconotide alone
Successful Trials
2.8
2.5
2.8
2.6
2.2
12
16
1.8
5
5
Dose Distribution
Diagnoses of Successful Trials
Metastatic Disease
10
Metastasis to Spine
10
3
Post-laminectomy Pain
2
Locally Advanced Disease
CIPN
1
Compression Fractures
1
Other
3
Conclusions
• Single shot intrathecal ziconotide 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.