The gift of Gaba?

Top Line: Does prophylactic gabapentin reduce the severity of patient-reported mucositis during head and neck radiation?

The Study: Retrospective studies have reported reduced opioid use and feeding tube placement with prophylactic gabapentin. However, prospective data is limited and conflicting. In particular, many studies have included multiple primary tumor sites, which could influence the potential severity of mucositis. In this phase 3 trial, 58 patients receiving chemoradiation for locally advanced oropharyngeal cancer were randomized to receive gabapentin or placebo during treatment. Gabapentin was started during the first week of treatment at 300 mg TID and then increased to 600 mg TID during the second week and through the duration of treatment. This max dose was chosen to limit adverse drug side effects and also to be safe in the event of cisplatin-induced nephrotoxicity. One week after treatment, gabapentin was titrated down and discontinued. Over the course of treatment, there was no difference in patient-reported oropharyngeal mucositis symptoms. There was also no difference in opioid use between arms. While there was no difference in percent weight loss between arms, the rate of feeding tube placement was significantly higher in the gabapentin arm (62%) compared to the placebo arm (21%). Maybe oral massage is worth a try?

TBL: In this randomized trial of patients receiving definitive chemoradiation for oropharyngeal cancer, prophylactic gabapentin (600 mg TID) did not reduce symptoms of mucositis, opioid use, or the need for feeding tube placement. | Cook, Int J Radiat Oncol Biol Phys 2021