Gabapentinoids for Oncologic Pruritus: A Retrospective Cohort Study.

Abstract

Background: Pruritus is a debilitating symptom in oncologic patients which often leads to treatment interruptions or dose reductions and reduced quality of life. Gabapentinoids such as gabapentin and pregabalin approved for postherpetic neuralgia, partial seizures, neuropathic pain, and fibromyalgia have also demonstrated efficacy in treating non-oncologic forms of pruritus. We report on the safety and efficacy of gabapentinoids for oncologic pruritus.

Patients and methods: This was a single-center retrospective cohort study conducted at the Memorial Sloan Kettering Cancer Center (MSK). All patients from 4/1/2019-8/1/2024 prescribed gabapentinoids for oncologic pruritus were retrospectively identified.

Results: 224 patients were included; the average age of the cohort was 63.2 ± 15 years and were mostly male (54%). Patients were treated for pruritus secondary to drug-induced causes (60.3%), malignancy/paraneoplastic (15.2%), cutaneous graft-versus-host disease (13.4%), and other etiologies (11.2%). Pregabalin was more frequently prescribed than gabapentin (80.8% vs. 19.2%). Ninety percent of patients (n = 202) experienced ≥1 grade improvement in CTCAE grade, at a median dosage 50 mg and 300 mg for pregabalin and gabapentin, respectively. The median time to patient-reported initial symptom improvement was 18.5 days. The median time to the documented ≥1 CTCAE grade improvement was 3.5 months (95% CI: 3.0-4.7), with no significant difference observed between pruritus etiologies. Adverse events were reported in 14.7% of patients, most commonly sedation (8.5%). Only three patients discontinued gabapentinoids due to adverse events.

Conclusion: Our results demonstrate that gabapentinoids are a safe and effective way to treat oncologic pruritus.