mirogabalin and Cancer-Pain

Mirogabalin, a selective voltage-gated calcium channel α2δ ligand, improves peripheral neuropathic pain; however, its effects on patients with cancers including pancreatic ductal adenocarcinoma (PDAC) remain unknown. We analyzed the effects of mirogabalin on a KPPC ( LSL-KrasG12D/+; Trp53flox/flox; Pdx-1cre/+ ) mouse model of PDAC. Six-week-old KPPC mice received oral mirogabalin (10 mg/kg/day) (n = 10) or vehicle water (n = 14) until the humane end point. Cancer-associated pain was evaluated using the scores of hunching and mouse grimace scale (MGS). Tumor status and plasma cytokine levels were determined using histopathological analysis and cytokine array, respectively. The effects of mirogabalin on the proliferative ability of PDAC cell lines were determined. The scores of the hunching and MGS improved after mirogabalin administration with a decrease in the plasma levels of inflammatory cytokines, such as tumor necrosis factor-α, interleukin-6, and interferon-γ. Although no significant difference in the survival rate was observed, mirogabalin significantly increased pancreatic tumor size and proliferative index of Ki-67 and cyclins. Local arginase-1 + M2-like tumor-associated macrophages and CD31 + tumor blood vessels increased after mirogabalin administration. By contrast, the number of α-smooth muscle actin + cancer-associated fibroblasts, desmoplastic stroma, and CD8 + T cells decreased. Local myeloperoxidase + tumor-associated neutrophils and CD45R + B cells were unaltered. Mirogabalin enhanced the proliferative ability of PDAC cell lines with the upregulation of cyclins and cyclin-dependent kinases; however, it inhibited the potential of pancreatic stellate cells in vitro. Therefore, our results suggest that mirogabalin improves cancer-associated pain but enhances the proliferative potential of PDAC in vitro and in vivo.

Topics: Animals; Cancer Pain; Carcinoma, Pancreatic Ductal; Cytokines; Mice; Pancreatic Neoplasms

Mirogabalin is a novel drug for alleviating peripheral neuropathic pain, available since April 2019 in Japan. Since cancer pain was not included as an outcome in clinical trials for product approval, there have been no reports on its effectiveness or safety for treating cancer pain. The purpose of this study was to evaluate the effectiveness and safety of mirogabalin for patients with cancer pain. During the 5 months from April to August 2019, our palliative care team prescribed mirogabalin to 34 patients who had not achieved effective analgesia even after opioid titration. Effectiveness was defined as(1)reduction in persistent pain of 50% or more on the numeric rating scale(NRS); or(2)reduction in the frequency of rescue medicine of 50% or more for breakthrough pain. Based on this definition, the rate of effectiveness of mirogabalin was 88.2%. Two patients experienced mild side effects in the central nervous system. However, these effects did not result in discontinuation of the medication. The results of the study showed that mirogabalin can be used effectively and safely for cancer pain relief.

Topics: Analgesics; Analgesics, Opioid; Bridged Bicyclo Compounds; Cancer Pain; Humans; Japan