Opioids With or Without Olanzapine in Treating Patients With Moderate to Severe Cancer Pain

March 7, 2012 updated by: Mayo Clinic

Analgesic Effect of Olanzapine in Cancer Pain: A Double-Blind Randomized Placebo-Controlled Parallel Group Pilot Study

RATIONALE: Opioids lessen pain caused by cancer. It is not yet known whether opioids are more effective when given together with or without olanzapine in treating cancer pain.

PURPOSE: This randomized clinical trial is studying opioids to see how well they work when given together with or without olanzapine in treating patients with moderate to severe cancer pain.

Study Overview

Status

Withdrawn

Conditions

Intervention / Treatment

Detailed Description

OBJECTIVES:

  • To assess the analgesic effect of olanzapine when administered in combination with opioids in patients with cancer pain.
  • To assess the opiod-sparing effect of olanzapine vs placebo.
  • To assess the effect of olanzapine on opioid adverse effects.

OUTLINE: Patients undergo opioid titration with a step 3 opioid to maintain a less than 4/10 level of pain (on a 0-10 numeric pain rating scale) to establish a opioid starting dose. When the pain rating increases, patients are randomized to 1 of 3 treatment arms.

  • Arm I: Patients receive oral opioid and oral placebo once daily for 4 weeks.
  • Arm II: Patients receive oral opioid and 2.5 mg oral olanzapine once daily for 4 weeks.
  • Arm III: Patients receive oral opioid and 5 mg oral olanzapine once daily for 4 weeks.

Patients undergo quality of life assessments at baseline and three times weekly by questionnaires using a scale from 0-3 and pain assessments periodically by Brief Pain Inventory, Edmonton Symptom Assessment Scale, Linear Analogue Scale Assessments, and Mini-Mental State Examination.

Study Type

Interventional

Phase

  • Not Applicable

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 70 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

DISEASE CHARACTERISTICS:

  • Moderate to severe cancer pain

    • Pain score ≥ 7/10 (0-10 numeric pain rating scale)
    • Requires strong opioids (step 3) for pain control or are already on stable doses of step 3 opioids
  • Opioid induced cognitive dysfunction or cognitive impairment, defined as cognitive disorder not otherwise specified according to Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) allowed

  • No nonmalignant pain

    • If patient has both malignant and nonmalignant pain, eligibility will be determined by the predominant site of pain

PATIENT CHARACTERISTICS:

  • Life expectancy ≥ 3 months
  • Normal renal function
  • Not pregnant or nursing
  • Negative pregnancy test
  • Must have a telephone
  • Able to complete patient questionnaires alone or with assistance
  • No delirium
  • No hepatic dysfunction
  • No nursing home patients
  • No intractable nausea or vomiting
  • No true allergy or intolerance to opioids
  • No gastrointestinal pathology that influences absorption of opioids
  • No drug seeking behavior or recent substance abuse history
  • No major depression
  • No respiratory compromise
  • No evidence of severe or uncontrolled systemic disease (e.g., unstable or uncompensated respiratory, cardiac, hepatic, or renal disease)
  • No evidence of any other significant clinical disorder or laboratory finding that makes it undesirable for the patient to participate in the study

PRIOR CONCURRENT THERAPY:

  • More than 1 month since prior radiotherapy, chemotherapy, or radionuclides
  • More than 1 month since prior bisphosphonates
  • No prior surgery that influences absorption of opioids
  • No concurrent therapeutic procedures or treatments that influence pain
  • No concurrent active radiation or antineoplastic therapies
  • No concurrent retroviral therapies
  • No concurrent drugs that interfere with CYP34A, CYP1A2, or CYP2D6
  • No concurrent drugs that interfere with morphine metabolism
  • No concurrent medications that will influence the disposition of morphine or methadone
  • No other concurrent antiemetics, antianxiety, or neuroleptic agents

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Supportive Care
  • Allocation: Randomized
  • Masking: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Arm I
Patients receive oral opioid and oral placebo once daily for 4 weeks.
Other: placebo
Given orally
Experimental: Arm II
Patients receive oral opioid and 2.5 mg oral olanzapine once daily for 4 weeks.
Drug: olanzapine
Given orally
Experimental: Arm III
Patients receive oral opioid and 5 mg oral olanzapine once daily for 4 weeks.
Drug: olanzapine
Given orally

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Two-point pain improvement from baseline (0-10 numeric pain rating scale)

Secondary Outcome Measures

Outcome Measure
Comparison of active treatment vs placebo
Effect of olanzapine on opiod adverse effects
Relationships between endpoints

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Mayo Clinic

Collaborators

National Cancer Institute (NCI)

Investigators

  • Study Chair: Eric E. Prommer, MD, Mayo Clinic

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

August 1, 2008

Primary Completion (Actual)

November 1, 2009

Study Completion (Actual)

November 1, 2009

Study Registration Dates

First Submitted

August 15, 2008

First Submitted That Met QC Criteria

August 15, 2008

First Posted (Estimate)

August 18, 2008

Study Record Updates

Last Update Posted (Estimate)

March 9, 2012

Last Update Submitted That Met QC Criteria

March 7, 2012

Last Verified

March 1, 2012

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • CDR0000588630
  • P30CA015083 (U.S. NIH Grant/Contract)
  • MCS930 (Other Identifier: Mayo Clinic Cancer Center)
  • 07-007571 (Other Identifier: Mayo Clinic IRB)

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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