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J Pain Symptom Manage. 2019 May 29. pii: S0885-3924(19)30294-5. doi: 10.1016/j.jpainsymman.2019.05.012. [Epub ahead of print]

Cebranopadol, a novel first-in-class analgesic drug candidate: first experience with cancer-related pain for up to 26 weeks.

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Innovation Unit Pain, Clinical Science, Grünenthal GmbH, Aachen, Germany. Electronic address:
Innovation Unit Pain, Clinical Science, Grünenthal GmbH, Aachen, Germany.
Data Sciences - Statistics, Grünenthal GmbH, Aachen, Germany.
Global Drug Safety, Grünenthal GmbH, Aachen, Germany.
Department of Oncology, University of Sheffield, Sheffield, UK.



Pain is one of the most prevalent symptoms associated with cancer. Strong opioids are commonly used in the analgesic management of the disease, but carry the risk of severe side effects. Cebranopadol is a first-in-class drug candidate, combining nociceptin/orphanin FQ peptide and opioid peptide receptor agonism. For cancer patients, frequently experiencing multimorbidities and often exposed to polypharmacy, cebranopadol is easy to handle given its once-daily dosing, the small tablet size that enables swallowing, and the option to flexibly titrate to an effective dose.


We assessed the safety and tolerability of prolonged treatment with oral cebranopadol for up to 26 weeks in patients suffering from chronic moderate to severe cancer-related pain.


This was a non-randomized, multi-site, open-label, single-arm clinical trial with patients who had completed a double-blind trial comparing morphine prolonged release (PR) with cebranopadol. In this extension trial, patients were treated with oral cebranopadol for up to 26 weeks.


Cebranopadol was safe and well tolerated in patients with chronic moderate to severe pain related to cancer in the dose range tested (200 to 1,000 μg once daily). The median and mean pain levels remained in the range of mild pain during the treatment period.


Our data suggest that cebranopadol was safe and well tolerated when administered for up to 26 weeks in patients with chronic cancer-related pain who were previously treated with cebranopadol or morphine PR.


cancer pain; cebranopadol; nociceptin/orphanin FQ peptide; open-label; prolonged treatment

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