Study of Breakthrough Cancer Pain: Assessment of Fentanyl Buccal Tablets Titration and Treatment in Opioid-Tolerant Patients

A European Multicenter Open-Label Study of Breakthrough Cancer Pain: Assessment of Fentanyl Buccal Tablets Titration and Treatment in Opioid-Tolerant Patients

Breakthrough cancer pain (BTcP) is a common problem in patients with cancer. Fentanyl Buccal Tablet (FBT) is used for the treatment of BTP in adults with cancer who are already receiving maintenance opioid therapy for chronic cancer pain. FBT treatment should be individually titrated to an effective dose that provides adequate analgesia and minimizes undesirable effects. To reach the safest effective dose for the individual patient as soon as possible, the dose titration process is critical. The aim of this study, conducted under pragmatic conditions in a large-scale population of cancer patients is to compare the proportion of patients reaching an effective FBT dose after titration starting with either a 100 mcg dose or a 200 mcg dose.

Study Overview

• Status: Terminated
• Conditions: Breakthrough Pain; Cancer Pain
• Intervention / Treatment: Drug: Fentanyl Buccal Tablet (FBT)

• Study Type: Interventional
• Enrollment (Actual): 330
• Phase: Phase 4

Contacts and Locations

Study Locations

• France
  • Bayonne, France, 64100
    • Investigational Site
  • Bordeaux, France, 33075
    • Investigational Site
  • Caen, France, 14033
    • Investigational Site
  • Clichy, France, 92110
    • Investigational Site
  • Grenoble, France, 38043
    • Investigational Site
  • Le Chesnay, France, 78157
    • Investigational Site
  • Le Kremlin Bicetre, France, 94275
    • Investigational Site
  • Le Mans, France, 72018
    • Investigational Site
  • Lorient, France, 58107
    • Investigational Site
  • Montpellier, France, 34298
    • Investigational Site
  • Nevers, France, 58033
    • Investigational Site
  • Orleans, France, 45032
    • Investigational Site
  • Paris, France, 75010
    • Investigational Site
  • Paris, France, 75013
    • Investigational Site
  • Paris, France, 75730
    • Investigational Site
  • Pierre Benite, France, 69495
    • Investigational Site
  • Poitiers, France, 86021
    • Investigational Site
  • Rouen, France, 76031
    • Investigational Site
  • Saint Herblain, France, 44805
    • Investigational Site
  • Tarbes, France, 65000
    • Investigational Site
  • Toulouse, France, 31059
    • Investigational Site
  • Villejuif, France, 94800
    • Investigational Site
• Germany
  • Bad Honnef, Germany, 53604
    • Investigational Site
  • Bad Lippspringe, Germany, 33175
    • Investigational Site
  • Berlin, Germany, 13353
    • Investigational Site
  • Berlin, Germany, 10435
    • Investigational Site
  • Berlin, Germany, 13585
    • Investigational Site
  • Berlin, Germany, 14089
    • Investigational Site
  • Bohlen, Germany, 04564
    • Investigational Site
  • Bonn, Germany, 53111
    • Investigational Site
  • Dresden, Germany, 01307
    • Investigational Site
  • Duisburg, Germany, 47055
    • Investigational Site
  • Duisburg, Germany, 47166
    • Investigational Site
  • Erfurt, Germany, 99084
    • Investigational Site
  • Freiburg, Germany, 79108
    • Investigational Site
  • Geesthacht, Germany, 21502
    • Investigational Site
  • Greifenstein, Germany, 35753
    • Investigational Site
  • Hannover, Germany, 30625
    • Investigational Site
  • Herne, Germany, 44623
    • Investigational Site
  • Hildesheim, Germany, 31135
    • Investigational Site
  • Jena, Germany, 07747
    • Investigational Site
  • Kassel, Germany, 34117
    • Investigational Site
  • Leipzig, Germany, 04107
    • Investigational Site
  • Lohsa, Germany, 02999
    • Investigational Site
  • Lunen, Germany, 44534
    • Investigational Site
  • Mainz, Germany, 55131
    • Investigational Site
  • Mulhausen, Germany, 99974
    • Investigational Site
  • Munich, Germany, 80637
    • Investigational Site
  • Munich, Germany, 81377
    • Investigational Site
  • Neustadt, Germany, 01844
    • Investigational Site
  • Rostock, Germany, 18059
    • Investigational Site
  • Weiden, Germany, 92637
    • Investigational Site
  • Wurselen, Germany, 52146
    • Investigational Site
• Ireland
  • Dublin, Ireland
    • Investigational Site
• Italy
  • Aquila, Italy, 67100
    • Investigational Site
  • Aviano, Italy, 33081
    • Investigational Site
  • Bari, Italy, 70120
    • Investigational Site
  • Brescia, Italy, 25123
    • Investigational Site
  • Cagliari, Italy, 9121
    • Investigational Site
  • Candiolo, Italy, 10060
    • Investigational Site
  • Caserta, Italy, 81100
    • Investigational Site
  • Cosenza, Italy, 87100
    • Investigational Site
  • Firenze, Italy, 50100
    • Investigational Site
  • Garbagnate Milanese, Italy, 20024
    • Investigational Site
  • Genova, Italy, 16128
    • Investigational Site
  • Lugo, Italy, 48022
    • Investigational Site
  • Milano, Italy, 20142
    • Investigational Site
  • Modena, Italy, 41100
    • Investigational Site
  • Napoli, Italy, 80131
    • Investigational Site
  • Palermo, Italy, 90146
    • Investigational Site
  • Piacenza, Italy, 29100
    • Investigational Site
  • Pisa, Italy, 56100
    • Investigational Site
  • Roma, Italy, 133
    • Investigational Site
  • Roma, Italy, 144
    • Investigational Site
  • Roma, Italy, 161
    • Investigational Site
  • Torino, Italy, 10126
    • Investigational Site
  • Torino, Italy, 10153
    • Investigational Site
  • Verona, Italy, 37024
    • Investigational Site
• Poland
  • Bielsko Biala, Poland, 43300
    • Investigational Site
  • Bydgoszcz, Poland, 85796
    • Investigational Site
  • Elblag, Poland, 82300
    • Investigational Site
  • Gdansk, Poland, 80208
    • Investigational Site
  • Gdansk, Poland, 80952
    • Investigational Site
  • Gliwice, Poland, 44101
    • Investigational Site
  • Lodz, Poland, 90251
    • Investigational Site
  • Poznan, Poland, 60245
    • Investigational Site
  • Poznan, Poland, 61866
    • Investigational Site
  • Puszczykowo, Poland, 62041
    • Investigational Site
  • Szczecin, Poland, 71730
    • Investigational Site
  • Szczecin, Poland, 71740
    • Investigational Site
  • Tychy, Poland, 43100
    • Investigational Site
  • Warszawa, Poland, 02781
    • Investigational Site
  • Wloclawek, Poland, 87800
    • Investigational Site
  • Wroclaw, Poland, 53413
    • Investigational Site
• Spain
  • A Coruna, Spain, 15006
    • Investigational Site
  • A Coruna, Spain, 15009
    • Investigational Site
  • Barcelona, Spain, 08025
    • Investigational Site
  • Barcelona, Spain, 08907
    • Investigational Site
  • Bilbao, Spain, 48013
    • Investigational Site
  • Cadiz, Spain, 11009
    • Investigational Site
  • Cordoba, Spain, 14002
    • Investigational Site
  • Granada, Spain, 18012
    • Investigational Site
  • LLeida, Spain, 28195
    • Investigational Site
  • La Laguna, Spain, 38320
    • Investigational Site
  • Madrid, Spain, 28006
    • Investigational Site
  • Madrid, Spain, 28035
    • Investigational Site
  • Madrid, Spain, 28046
    • Investigational Site
  • Palma de Mallorca, Spain, 07012
    • Investigational Site
  • Pamplona, Spain, 31008
    • Investigational Site
  • Salamanca, Spain, 37007
    • Investigational Site
  • Santander, Spain, 39008
    • Investigational Site
  • Santiago de Compostela, Spain, 15706
    • Investigational Site
  • Sevilla, Spain, 41009
    • Investigational Site
  • Sevilla, Spain, 41013
    • Investigational Site
  • Valencia, Spain, 46014
    • Investigational Site
  • Valencia, Spain, 46015
    • Investigational Site
• United Kingdom
  • Bath, United Kingdom, BA15 2LG
    • Investigational Site
  • Dumfries, United Kingdom, DG1 4AP
    • Investigational Site
  • London, United Kingdom, SW3 6JJ
    • Investigational Site
  • Nottingham, United Kingdom, NG5 1PB
    • Investigational Site
  • Plymouth, United Kingdom, PL68DH
    • Investigational Site
  • Surrey, United Kingdom, KT10 8NA
    • Investigational Site
  • Sutton, United Kingdom, SM2 5PT
    • Investigational Site

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• The patient is willing to provide written informed consent to participate in this study.
• The patient can be either an out-patient or an in-patient.
• The patient has a histologically documented diagnosis of cancer.
• The patient has stable background pain due to cancer.
• The patient experiences up to 4 BTcP episodes per 24 hours.
• As maintenance opioid therapy, the patient is currently taking 1 of the following: at least 60 mg of oral morphine/day, at least 25 mcg of transdermal fentanyl/hour, at least 30 mg of oxycodone/day, at least 8 mg of hydromorphone/day, of an equianalgesic dose of another opioid for a week or longer before administration of the first dose of study drug.
• Women of childbearing potential, using a medically accepted, highly effective method of birth control and agree to continued use of this method for the duration of the study.
• The patient must be willing and able to successfully self-administer the study drug and to fill in study documents.

Exclusion Criteria:

• The patient is without maintenance opioid therapy.
• The patient has uncontrolled or rapidly escalating pain as determined by the investigator.
• The patient has known or suspected hypersensitivities, allergies, or other contraindications to the active drug or to any of the excipients of the study drug.
• The patient has respiratory depression or chronic obstructive pulmonary disease, or any other medical condition predisposing to respiratory depression.
• The patient has medical or psychiatric disease that, in the opinion of the investigator, would compromise collected data.
• The patient is expected to have surgery during the study.
• The patient is pregnant or lactating.
• The patient has participated in a study involving an investigational drug in the prior 30 days.
• The patient has received a monoamine oxidase inhibitor (MAOI) within 14 days before the first treatment with study drug.
• The patient has any other medical condition or is receiving concomitant medication/therapy (e.g., regional nerve block) that could, in the opinion of the investigator, compromise the patient's safety or compliance with the study protocol, or compromise collected data.

Study Plan

How is the study designed?

Design Details

• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: FBT 100 mcg; During the Titration Period, participants took fentanyl buccal tables (FBT) with a starting dose of 100 mcg until they reached an effective dose, with a maximum dose of 800 mcg and a maximum timeframe of 7 days. Participants who reached an effective dose entered the Open-label Treatment Period, whose length depended on how long was needed to treat up to 8 episodes of breakthrough pain (BTP) with FBT (maximum of 8 days). The length of the Continuation Period (when applicable) varied from country to country, up to until FBT was commercially available in that country.	Drug: Fentanyl Buccal Tablet (FBT); FBTs were self-administered by participants via the oral mucosa. During the open-label dose titration period, participants used 1 to 4 tablets of the 100 mcg or 200 mcg strength to individually titrate upwards to an effective dose through the range of available strengths (i.e. 100, 200, 400, 600, or 800 mcg). For the open-label treatment and continuation periods, single dose tablets at the effective dose identified during the titration period were used. The maximum dose allowed per breakthrough pain (BTP) episode was 800 mcg. On any single day, participants were not to use FBT for more than 4 BTP episodes.; Other Names: Fentanyl citrate; Fentora; CEP-25608; Effentora
Active Comparator: FBT 200 mcg; During the Titration Period, participants took fentanyl buccal tables (FBT) with a starting dose of 200 mcg until they reached an effective dose, with a maximum dose of 800 mcg and a maximum timeframe of 7 days. Participants who reached an effective dose entered the Open-label Treatment Period, whose length depended on how long was needed to treat up to 8 episodes of breakthrough pain (BTP) with FBT (maximum of 8 days). The length of the Continuation Period (when applicable) varied from country to country, up to until FBT was commercially available in that country.	Drug: Fentanyl Buccal Tablet (FBT); FBTs were self-administered by participants via the oral mucosa. During the open-label dose titration period, participants used 1 to 4 tablets of the 100 mcg or 200 mcg strength to individually titrate upwards to an effective dose through the range of available strengths (i.e. 100, 200, 400, 600, or 800 mcg). For the open-label treatment and continuation periods, single dose tablets at the effective dose identified during the titration period were used. The maximum dose allowed per breakthrough pain (BTP) episode was 800 mcg. On any single day, participants were not to use FBT for more than 4 BTP episodes.; Other Names: Fentanyl citrate; Fentora; CEP-25608; Effentora

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of Participants Reaching an Effective Fentanyl Buccal Tablet (FBT) Dose As Assessed by the Participant During the Titration Period	The effective dose was the dose that, for 2 consecutive break-through pain (BTP) episodes, provided adequate analgesia within the first 30 minutes after administration of study drug and that minimized undesirable effects. The assessment was performed by the participant and was reported in the titration-period diary. The next BTP episode was used to confirm the effective dose, and if confirmed, the effective dose was used for all following BTP episodes.	Day 1 up to Day 7

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Kaplan-Meier Estimates for Time to Meaningful Pain Relief As Assessed by Participants During the Treatment Period For Overall Breakthrough Pain (BTP) Episodes	Overall episode data analyzed all values of time to meaningful pain relief taken over all BTP episodes during the treatment period. If meaningful pain relief was not achieved within 60 minutes of FBT intake, or if rescue medication was taken, the event was censored. Meaningful pain relief was left to the judgment of participants, who used a stopwatch and recorded the time from treatment until pain relief in a patient diary.	approximately Day 8-15
Number of Participants Reaching An Effective Dose As Assessed by the Participant During the Titration Period	Number of participants for which an effective dose of FBT was reached as judged by each participant. The effective dose was the dose that, for 2 consecutive break-through pain (BTP) episodes, provided adequate analgesia within the first 30 minutes after administration of study drug and that minimized undesirable effects. The assessment was performed by the participant and was reported in the titration-period diary. The next BTP episode was used to confirm the effective dose, and if confirmed, the effective dose was used for all following BTP episodes.	Day 1 up to Day 7
Breakthrough Pain (BTP) Episodes Requiring the Use of Rescue Medication During the Titration Period and the Treatment Period	The number of breakthrough pain (BTP) episodes in which the participant did not obtain effective pain relief from study medication and took a rescue medication.	Days 1 to up to Day 7 (Titration Period); approximately Day 8 up to Day 15 (Treatment Period)
Participant Assessment of Medication Performance During the Treatment Period	Participants assessed the performance of FBT at 30 minutes and 60 minutes after dosing each episode during the treatment period. For each episode, the participant answered the question 'How well did your study medication perform in controlling the breakthrough pain episode?' on a 5-point Likert-type scale (poor=0, fair=1, good=2, very good=3, and excellent=4).	approximately Day 8-15
Change From Baseline to End of Treatment Period (Approximately Day 15) in the Brief Pain Inventory 7-item (BPI-7S) Questionnaire Subscale: General Activity	Participants completed the BPI-7S questionnaire to indicate their quality of life and functional status between study time points. For each subscale, the participant rated their responses from 0=Does not interfere through to 10=Completely interferes. A negative change from baseline represents an improvement. This subscale assesses general activity.	Day 0 (baseline), approximately Day 15 (end of Treatment Period)
Change From Baseline to End of Treatment Period (Approximately Day 15) in the Brief Pain Inventory 7-item (BPI-7S) Questionnaire Subscale: Mood	Participants completed the BPI-7S questionnaire to indicate their quality of life and functional status between study time points. For each subscale, the participant rated their responses from 0=Does not interfere through to 10=Completely interferes. A negative change from baseline represents an improvement. This subscale assesses mood.	Day 0 (baseline), approximately Day 15 (end of Treatment Period)
Change From Baseline to End of Treatment Period (Approximately Day 15) in the Brief Pain Inventory 7-item (BPI-7S) Questionnaire Subscale: Walking Ability	Participants completed the BPI-7S questionnaire to indicate their quality of life and functional status between study time points. For each subscale, the participant rated their responses from 0=Does not interfere through to 10=Completely interferes. A negative change from baseline represents an improvement. This subscale assesses walking ability.	Day 0 (baseline), approximately Day 15 (end of Treatment Period)
Change From Baseline to End of Treatment Period (Approximately Day 15) in the Brief Pain Inventory 7-item (BPI-7S) Questionnaire Subscale: Normal Work	Participants completed the BPI-7S questionnaire to indicate their quality of life and functional status between study time points. For each subscale, the participant rated their responses from 0=Does not interfere through to 10=Completely interferes. A negative change from baseline represents an improvement. This subscale assesses normal work.	Day 0 (baseline), approximately Day 15 (end of Treatment Period)
Change From Baseline to End of Treatment Period (Approximately Day 15) in the Brief Pain Inventory 7-item (BPI-7S) Questionnaire Subscale: Relations With Other People	Participants completed the BPI-7S questionnaire to indicate their quality of life and functional status between study time points. For each subscale, the participant rated their responses from 0=Does not interfere through to 10=Completely interferes. A negative change from baseline represents an improvement. This subscale assesses relations with other people.	Day 0 (baseline), approximately Day 15 (end of Treatment Period)
Change From Baseline to End of Treatment Period (Approximately Day 15) in the Brief Pain Inventory 7-item (BPI-7S) Questionnaire Subscale: Sleep	Participants completed the BPI-7S questionnaire to indicate their quality of life and functional status between study time points. For each subscale, the participant rated their responses from 0=Does not interfere through to 10=Completely interferes. A negative change from baseline represents an improvement. This subscale assesses sleep.	Day 0 (baseline), approximately Day 15 (end of Treatment Period)
Change From Baseline to End of Treatment Period (Approximately Day 15) in the Brief Pain Inventory 7-item (BPI-7S) Questionnaire Subscale: Enjoyment of Life	Participants completed the BPI-7S questionnaire to indicate their quality of life and functional status between study time points. For each subscale, the participant rated their responses from 0=Does not interfere through to 10=Completely interferes. A negative change from baseline represents an improvement. This subscale assesses enjoyment of life.	Day 0 (baseline), approximately Day 15 (end of Treatment Period)
Change From Baseline to End of Treatment Period (Approximately Day 15) in the Brief Pain Inventory 7-item (BPI-7S) Questionnaire: Global Score	Participants completed the BPI-7S questionnaire to indicate their quality of life and functional status between study time points. For each subscale, the participant rated their responses from 0=Does not interfere through to 10=Completely interferes. The Global Score is the sum of the subscales (total scale is 0-70). A negative change from baseline represents an improvement.	Day 0 (baseline), approximately Day 15 (end of Treatment Period)
Participant's Global Assessment of Satisfaction (Satisfied With BTP Treatment?) at the End of the Treatment Period	Responses to the Patient Satisfaction questionnaire question, "Satisfied with the BTP Treatment?", were captured on a five-point scale from 0=not at all to 4=very much.	approximately Day 15 (end of Treatment Period)
Participant's Global Assessment of Satisfaction (Does This BTP Medication Relieve Your Pain Quickly so You Can Get Back to Sleep?) at the End of the Treatment Period	Responses to the Patient Satisfaction questionnaire question, "Does this BTP medication relieve your pain quickly so you can get back to sleep?", were captured on a five-point scale from 0=not at all to 4=very much.	approximately Day 15 (end of Treatment Period)
Participant's Global Assessment of Satisfaction (Does This Medication Work Fast?) at the End of the Treatment Period	Responses to the Patient Satisfaction questionnaire question, "Does this medication work fast?", were captured on a five-point scale from 0=not at all to 4=very much.	approximately Day 15 (end of Treatment Period)
Participant's Global Assessment of Satisfaction (Does This Medication Provide Adequate Relief?) at the End of the Treatment Period	Responses to the Patient Satisfaction questionnaire question, "Does this medication provide adequate relief?", were captured on a five-point scale from 0=not at all to 4=very much.	approximately Day 15 (end of Treatment Period)
Participant's Global Assessment of Satisfaction (Is This Medication Easy to Take?) at the End of the Treatment Period	Responses to the Patient Satisfaction questionnaire question, "Is this medication easy to take?", were captured on a five-point scale from 0=not at all to 4=very much.	approximately Day 15 (end of Treatment Period)
Participant's Global Assessment of Satisfaction (Do You Find This Medication Comfortable to Take in Public?) at the End of the Treatment Period	Responses to the Patient Satisfaction questionnaire question, "Do you find this medication comfortable to take in public?", were captured on a five-point scale from 0=not at all to 4=very much.	approximately Day 15 (end of Treatment Period)
Participant's Global Assessment of Satisfaction (Do You Feel Safe Taking This Medication?) at the End of the Treatment Period	Responses to the Patient Satisfaction questionnaire question, "Do you feel safe taking this medication?", were captured on a five-point scale from 0=not at all to 4=very much.	approximately Day 15 (end of Treatment Period)
Participant's Global Assessment of Satisfaction (Do You Understand the Instructions?) at the End of the Treatment Period	Responses to the Patient Satisfaction questionnaire question, "Do you understand the instructions?", were captured on a five-point scale from 0=not at all to 4=very much.	approximately Day 15 (end of Treatment Period)
Participant's Global Assessment of Ease of Use at the End of the Treatment Period	Ease of use was assessed using the question 'Did you find this treatment easy/convenient to use for treatment of your breakthrough pain episodes?'. The answer was based on a 4-point numerical scale (0=Poor, 1=Fair, 2=Easy, 3=Very Easy). This assessment was performed at the end of the Treatment Period (or early termination).	approximately Day 15 (end of Treatment Period)
Participant's Global Impression of Change at the End of the Treatment Period	Global impression of change was assessed using the question 'Since the start of the study, my overall status is?'. The answer was based on a 7-point scale (1=Very much improved, 2=Much improved, 3=Minimally improved, 4=No change, 5=Minimally worse, 6=Much worse, and 7=Very much worse). This assessment was performed at the end of the Treatment Period (or early termination).	approximately Day 15 (end of Treatment Period)
Participants With Adverse Events (AE) Summarized by Treatment Period	Participants with treatment-emergent adverse events are summarized by each treatment period. Relation to study drug was assessed by the investigator. The 'Any AE' category below includes serious adverse events.	Day 1-7 (Titration Period). Day 8-15 (Treatment Period), Days 16-688 (Continuation Period)

Collaborators and Investigators

• Sponsor: Cephalon
• Investigators: Study Director: Sponsor's Medical Expert, Cephalon Europe

Study record dates

Study Major Dates

• Study Start: January 1, 2009
• Primary Completion (Actual): May 1, 2011
• Study Completion (Actual): May 1, 2011

Study Registration Dates

• First Submitted: January 29, 2009
• First Submitted That Met QC Criteria: February 11, 2009
• First Posted (Estimate): February 12, 2009

Study Record Updates

• Last Update Posted (Estimate): October 1, 2012
• Last Update Submitted That Met QC Criteria: September 19, 2012
• Last Verified: September 1, 2012

More Information

Terms related to this study

• Keywords: Breakthrough Cancer Pain
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Breakthrough Pain; Cancer Pain; Physiological Effects of Drugs; Central Nervous System Depressants; Peripheral Nervous System Agents; Analgesics; Sensory System Agents; Anesthetics, Intravenous; Anesthetics, General; Anesthetics; Analgesics, Opioid; Narcotics; Adjuvants, Anesthesia; Fentanyl
• Other Study ID Numbers: C25608/4027/BP/EU; 2008-001841-24 (EudraCT Number)