BPI20-024: Targeted Drug Delivery (TDD) for Cancer-Related Pain: Emerging Evidence

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  • a Center for Pain and Supportive Care, Phoenix, AZ
  • b University Of Utah, Salt Lake City, UT
  • c Medtronic, Inc. Minneapolis, MN

Introduction World Health Organization guidelines identified inadequate cancer pain management as a global health concern, with the analgesic ladder developed to support stepwise progression to strong opioids as necessary. The 2018 National Comprehensive Cancer Network (NCCN) pain guidelines recommend a similar stepwise algorithm, and link survival to disease/symptom control, including pain management, and to quality of life. Recent studies, however, indicate cancer pain remains undertreated in 25% to 77% of patients. TDD has demonstrated improvements in cancer-related pain management compared to conventional medical management (CMM) in randomized clinical trials and single-center evaluations. Therapy awareness, however, remains a primary barrier to access for this treatment option. Presented here is an overview of existing data and recent publications related to TDD. Methods A review of existing clinical evidence and recent publications was completed to assess TDD’s merit as a treatment for cancer pain. Results RCT studies have previously demonstrated improvements in pain control and relief from common opioid toxicities. A recent publication comparing TDD and CMM indicates a mean total cost savings of $15,142 at 2 months and $63,498 at 12 months with use of TDD. Evidence indicating negligible/undetectable serum opioid levels with TDD in addition to reductions in associated constipation severity has also been recently published. Real-world, long-term registry data on 1403 cancer patients treated with TDD is newly available, demonstrating significant improvements in pain (6 and 12 months) and quality of life (6 months) compared to baseline, with infection requiring surgical intervention reported in 3.2% of patients. Conclusion Adequate and improved pain control in cancer patients, even those with disease progression nearing end-of-life, with concurrent quality of life maintenance is an attainable goal, as is reduction in risks associated with systemic opioid use. Broader awareness of existing data and recent additions to the overall evidence in support of TDD should help address undertreatment of cancer-related pain.

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Corresponding Author: Robert J. Spencer, MS, MBA
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