Clinical outcomes of gabapentinoids for oncologic pruritus: A retrospective cohort study.

Abstract

12066 Background: Pruritus is a debilitating symptom in oncologic patients, sometimes leading to interruption of cancer therapy. Gabapentinoids such as gabapentin and pregabalin are effective for the treatment of uremic and neuropathic pruritus. We report on the safety and efficacy of gabapentinoids for oncologic pruritus defined as any pruritus originating from malignancy, oncologic therapies, or other cancer-associated toxicities, such as cutaneous graft-versus-host disease (GVHD). Methods: In this single-center retrospective cohort study conducted at the Memorial Sloan Kettering Cancer Center between 4/1/2019 and 8/1/2024, 224 patients who were prescribed gabapentinoids for oncologic pruritus were included. Patients taking gabapentinoids for indications other than pruritus were excluded. The primary efficacy endpoint was ≥ 1-grade improvement for pruritus severity on the Common Terminology Criteria for Adverse Events (CTCAE) v5.0 scale. Results: The cohort was predominantly male (54%) and White (67%), with Black (14.3%) and Asian (12.5%) patients also represented; the mean age was 63.2 ± 15 years. Gabapentinoids were most prescribed for drug-induced causes (58.9%) and malignancy-related pruritus (14.3%). Of the drug-induced causes, immune checkpoint inhibitors (40.2%), monoclonal antibodies (12.9%; including mogamulizumab, brentuximab vedotin, and enfortumab vedotin), and tyrosine kinase inhibitors (11.4%) were the most common triggers. Pregabalin was more commonly prescribed compared to gabapentin (80.8% vs. 19.2%). Ninety percent of patients (n=202) experienced a ≥1-CTCAE grade improvement at a median total daily dosage of 50 mg (IQR, 25 mg) for pregabalin and 300 mg (IQR, 50 mg) for gabapentin. Median time for patient-reported improvement was 18.5 days and there was no significant difference in gabapentin response between pruritus etiologies. The most common adverse event was sedation (8.5%), with 3 patients discontinuing gabapentinoids due to fatigue. Conclusions: This study is the first to report that gabapentinoids are a safe and effective way to treat oncologic pruritus stemming from malignancy, cancer therapies, or cutaneous GVHD. Prospective trials would further establish gabapentinoids’ safety and efficacy profile in the oncologic population. Outcomes & adverse events of patients on gabapentinoids. Variable Category/Statistic N (%) CTCAE Grade Change Did Not Improve (0 Grade) 22 (9.8%) Improved 1 Grade 132 (58.9%) Improved ≥ 2 Grade 70 (31.3%) Antineoplastic Therapy Interrupted Due to Oncologic Pruritus Yes 26 (11.7%) No 157 (70.4%) Not Applicable 40 (17.9%) Adverse Events* Sedation 19 (8.5%) Leg Swelling 2 (0.9%) Other 9 (4.0%) *The remaining 194 (86.6%) patients did not report any adverse events related to the gabapentinoids.