Sativex® for Relieving Persistent Pain in Participants With Advanced Cancer

NCT ID: NCT01262651

Last Updated: 2018-04-23

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE3
• Total Enrollment: 397 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2010-11-25
• Study Completion Date: 2015-07-02

Brief Summary

This 9-week study aimed to determine the efficacy, safety and tolerability of nabiximols (Sativex®) as an adjunctive treatment, compared with placebo in relieving uncontrolled persistent chronic pain in participants with advanced cancer.

Eligible participants were not required to stop any of their current treatments or medications.

Detailed Description

This 9-week, multi-center, double-blind, randomized, placebo-controlled study aimed to determine the efficacy, safety and tolerability of nabiximols, administered as an adjunctive treatment for 5 weeks, versus placebo. Eligible participants had advanced cancer, with a clinical diagnosis of cancer related pain which was not wholly alleviated by their current optimized opioid treatment.

Qualifying participants entered the study at screening and commenced a 5 to 14 day eligibility period. During this period, eligible participants had 3 consecutive days where pain severity remained within defined parameters, break-through opioid usage had not exceeded an average of 4 episodes per day, and maintenance opioid medication and dose had not changed. Eligible participants returned for randomization on Day 1 and were randomized to either the nabiximols or placebo treatment arm using a 1:1 allocation ratio. Participants began an initial titration period that lasted up to 14 days. The titration schedule required dosing to a minimum of 3 sprays per day, after which participants were allowed to individualize their dose (3 to 10 sprays per day) until Day 14 when that dose was then fixed for the remainder of the study. Participants returned at Day 22 and Day 36 (end of the randomized treatment period), or earlier if they terminated prematurely from the study. After the end of the 5-week treatment period, participants were offered the option of entering an open-label extension (OLE) study; a safety follow up visit (up to Day 43) was not required if the participant entered the OLE on Day 36. Participants who entered the OLE, up to 7 days after study completion had their follow-up assessments performed on the same day as their first OLE study visit. Participants that did not enter the OLE study had a safety follow up visit 14 days after treatment completion, which could be via telephone.

Conditions

Pain; Advanced Cancer

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: TRIPLE

Study Groups

Nabiximols

Nabiximols was self-administered by participants as a 100 microliter (μL) oromucosal spray in the morning and evening, up to a maximum of 10 sprays per day for 5 weeks. Nabiximols oromucosal spray contained delta-9-tetrahydrocannabinol (THC) (27 milligram \[mg\]/milliliter \[mL\]):cannabidiol (CBD) (25 mg/mL), in ethanol:propylene glycol (50:50) excipients, with peppermint oil (0.05%) flavoring. Each 100 μL actuation delivered 2.7 mg THC and 2.5 mg CBD.

Group Type: EXPERIMENTAL

Nabiximols

Intervention Type: DRUG

Placebo (GA-0034)

Placebo Comparator: Placebo (GA-0034) Placebo was self-administered by participants as a 100 μL oromucosal spray in the morning and evening, up to a maximum of 10 sprays per day for 5 weeks. Placebo oromucosal spray contained ethanol: propylene glycol (50:50)

Group Type: PLACEBO_COMPARATOR

Placebo (GA-0034)

Intervention Type: DRUG

Interventions

Nabiximols

Intervention Type: DRUG

Placebo (GA-0034)

Intervention Type: DRUG

Other Intervention Names

Sativex®

Eligibility Criteria

Inclusion Criteria

• The participant had advanced cancer for which there was no known curative therapy
• The participant had a clinical diagnosis of cancer related pain, which was not wholly alleviated with their current optimized opioid treatment
• The participant received an optimized maintenance dose of Step 3 opioid therapy, preferably with a sustained release preparation, but also allowing a regular maintenance dose of around the clock use of immediate release preparations
• The participant received a daily maintenance dose Step 3 opioid therapy of less than or equal to a total daily opioid dose of 500 mg/day of morphine equivalence (including maintenance and break-through opioids)
• The participant was using no more than one type of break-through opioid analgesia

Exclusion Criteria

• The participant had any planned clinical interventions that would have affected their pain (for example, chemotherapy or radiation therapy where, in the clinical judgment of the investigator, these would be expected to affect pain)
• The participant was using or had used cannabis or cannabinoid-based medications within 30 days of study entry and is unwilling to abstain for the duration of the study
• The participant had experienced myocardial infarction or clinically significant cardiac dysfunction within the last 12 months or had a cardiac disorder that, in the opinion of the investigator, would have put the participant at risk of a clinically significant arrhythmia or myocardial infarction
• The participant had significantly impaired renal function
• The participant had significantly impaired hepatic function
• Female participants of child-bearing potential and male participants whose partner was of child-bearing potential, unless willing to ensure that they or their partner used effective contraception, for example, oral contraception, double barrier, intra-uterine device, during the study and for 3 months thereafter (however, a male condom was not to be used in conjunction with a female condom as this may not have proven effective)

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Otsuka Pharmaceutical Development & Commercialization, Inc.

INDUSTRY

Sponsor Role: collaborator

GW Pharmaceuticals Ltd

INDUSTRY

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Locations

Phoenix, Arizona, United States

Phoenix, Arizona, United States

El Cajon, California, United States

Gilroy, California, United States

Brandon, Florida, United States

Daytona Beach, Florida, United States

Holiday, Florida, United States

Jacksonville, Florida, United States

Lynn Haven, Florida, United States

Stuart, Florida, United States

Winter Park, Florida, United States

Newnan, Georgia, United States

Stockbridge, Georgia, United States

Shreveport, Louisiana, United States

Saint Louis Park, Minnesota, United States

Kansas City, Missouri, United States

Berlin, New Jersey, United States

Hendersonville, North Carolina, United States

Winston-Salem, North Carolina, United States

Philadelphia, Pennsylvania, United States

Houston, Texas, United States

Houston, Texas, United States

Laredo, Texas, United States

Salt Lake City, Utah, United States

Salt Lake City, Utah, United States

Brussels, , Belgium

Gabrovo, , Bulgaria

Shumen, , Bulgaria

Varna, , Bulgaria

České Budějovice, , Czechia

České Budějovice, , Czechia

Hradec Králové, , Czechia

Most, , Czechia

Nová Ves pod Pleší, , Czechia

Ostrava-Poruba, , Czechia

Pilsen, , Czechia

Lünen, , Germany

Stadtroda, , Germany

Wetzlar, , Germany

Deszk, , Hungary

Kecskemét, , Hungary

Komárom, , Hungary

Miskolc, , Hungary

Nyíregyháza, , Hungary

Szekszárd, , Hungary

Rēzekne, , Latvia

Riga, , Latvia

Klaipėda, , Lithuania

Šiauliai, , Lithuania

Vilnius, , Lithuania

Bialystok, , Poland

Bielsko-Biala, , Poland

Gliwice, , Poland

Poznan, , Poland

Warsaw, , Poland

Ponce, , Puerto Rico

San Juan, , Puerto Rico

Baia Mare, , Romania

Brăila, , Romania

Bucharest, , Romania

Craiova, , Romania

Oradea, , Romania

Satu Mare, , Romania

Suceava, , Romania

Bury, , United Kingdom

Bury St Edmunds, , United Kingdom

Edinburgh, , United Kingdom

Glasgow, , United Kingdom

Manchester, , United Kingdom

Norwich, , United Kingdom

Weston-super-Mare, , United Kingdom

Wolverhampton, , United Kingdom

Countries

United States; Belgium; Bulgaria; Czechia; Germany; Hungary; Latvia; Lithuania; Poland; Puerto Rico; Romania; United Kingdom

References

Lichtman AH, Lux EA, McQuade R, Rossetti S, Sanchez R, Sun W, Wright S, Kornyeyeva E, Fallon MT. Results of a Double-Blind, Randomized, Placebo-Controlled Study of Nabiximols Oromucosal Spray as an Adjunctive Therapy in Advanced Cancer Patients with Chronic Uncontrolled Pain. J Pain Symptom Manage. 2018 Feb;55(2):179-188.e1. doi: 10.1016/j.jpainsymman.2017.09.001. Epub 2017 Sep 18.

Reference Type: BACKGROUND

PMID: 28923526 (View on PubMed)

Other Identifiers

2009-016064-36

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

GWCA0958

Identifier Type: -

Identifier Source: org_study_id