CORAL - Cebranopadol Versus Morphine Prolonged-release in Patients With Chronic Moderate to Severe Pain Related to Cancer

Study Overview
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Brief Summary
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Pain is one of the most common symptoms associated with malignant tumor. The purpose of this trial is to determine whether cebranopadol is as effective in patients with cancer related pain as morphine sulfate prolonged release (PR).

Detailed Description
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The trial comprises an enrollment period, a treatment period (titration and maintenance), and a follow-up period. Participants will receive either cebranopadol or morphine PR for 44 days. Initially participants will be titrated after 2 and then every 4 days to a morphine PR or cebranopadol dose that provides adequate analgesia and is tolerated. The titration period is planned to last 16 days. Thereafter the dose of morphine PR or cebranopadol is to be kept stable for a further 28 days, i.e. no dose adjustments will be allowed during the maintenance period. This 28 day period is the maintenance period. The follow-up period is planned for up to 18 days after the end of last pain medication treatment intake.

Official Title
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Efficacy, Safety, and Tolerability of Oral Cebranopadol Versus Morphine Sulfate PR in Subjects With Chronic Moderate to Severe Pain Related to Cancer.

Conditions
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Pain, Neoplasms, Chronic Pain

Intervention / Treatment
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* Drug: Cebranopadol
* Drug: Morphine Prolonged Release


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Signed informed consent. Negative pregnancy test before first dose. Female and male participants willing to use acceptable and highly effective methods of birth control. The following criteria must be fulfilled by participants: Require daily analgesia for their pain, Diagnosed with active cancer, Receiving daily opioid treatment at doses not higher than 90 mg oral morphine or its equivalent (World Health Organization Step II and Step III analgesics) for an appropriate length of time, Participants must be dissatisfied with their current pain treatment, Participants must be suffering from cancer-related but not cancer therapy-related chronic pain for a period of 4 weeks or more prior to enrollment. Eastern Cooperation Oncology Group (ECOG) score 2 or below. Average pain intensity over the last 24 hours of 5 or more calculated from the pain assessments recorded during the last 3 days prior to randomization. Compliance with the use of the electronic diary defined as at least 3 out of 4 of the 24 hour Numerical Rating Scale entries available during the last 4 days prior to and including the day of allocation to treatment. Exclusion Criteria: Evidence of ongoing alcohol and or drug abuse and/or a history of alcohol and/or drug abuse within the last 2 years. A clinically significant disease other than cancer which in the investigator's opinion may affect efficacy or safety assessments e.g., significant unstable cardiac, vascular, pulmonary, gastrointestinal, endocrine, neurological, infectious disease, psychiatric (resulting in disorientation, memory impairment or inability to report accurately) or metabolic disorders. Any gastrointestinal disorder that could affect the absorption and/or elimination of Investigational Medicinal Product. Any planned major surgery during the trial. Known to or suspected of not being able to comply with the trial protocol and the use of Investigational Medicinal Product. History of seizure disorder and/or epilepsy or any condition associated with a significant risk of seizure or epilepsy. Known history and/or presence of cerebral tumor or cerebral metastases. Moderate to severe hepatic impairment corresponding to Child-Pugh classification B and C. Impaired hepatic cellular integrity indicated by aspartate transaminase or alanine transaminase greater than 3 times the upper limit of normal at the Enrollment Visit. Inadequate baseline bone marrow reserve with a white blood cell count below 2000/µL, a platelet count 100 000/µL or less, and a hemoglobin level below 8 g/dL at the Enrollment Visit. Impaired renal function. Creatinine clearance less than 60 mL per minute(as per amendment 45 mL per minute) at the Enrollment Visit (calculated from the Cockcroft-Gault formula). Forbidden concomitant medications Uncontrolled hypertension Clinically relevant history of hypersensitivity, allergy or contraindications to opioid medication or any of the excipients of morphine sulfate (Prolonged Released or Immediate Release), or cebranopadol film-coated tablets. Chronic hepatitis B or C, or human immunodeficiency virus (HIV) known by history, or presence of active hepatitis B or C within the 3 months before the Enrollment Visit. History of torsade de pointes and/or presence of risk factors for torsade de pointes (e.g., heart failure, hypokalemia, or bradycardia). Marked prolongation of corrected QT interval (Fridericia) (greater than 450 milliseconds) at the Enrollment Visit. Employees of the sponsor, investigator, or trial site or family members of the employees, sponsor, or investigator. Concurrent participation in another trial or planning to be enrolled in another clinical trial (i.e., administration of experimental treatment in another clinical trial) during the course of this trial. Previous participation in this or other trials with cebranopadol with the following exceptions: Participants who failed enrollment in this trial only because of exclusion criterion 10, and who may now be eligible can be re-enrolled. Participants who failed enrollment due to technical failure of equipment (e.g., ECG machine and e-diary device). Participant has received an experimental drug or used an experimental medical device within 30 days before the planned start of treatment. Currently not receiving opioid treatment for cancer-related pain at the enrollment visit (i.e., opioid naïve).

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Cebranopadol<br>Once daily oral administration. 200, 400 or 600 µg film coated tablets. Dosage 200 µg to 1000 µg per day. | Drug: Cebranopadol<br>* Participant will take one or two tablet(s) of cebranopadol in the morning and one or two placebo double-dummy morphine-like capsule(s) in the morning and the evening.<br>* Other names: GRT6005;|
| Active Comparator: Morphine Prolonged Release<br>Twice daily oral administration. 15, 30 or 45 mg morphine sulfate capsules. Dosage 30 to 150 mg per day. | Drug: Morphine Prolonged Release<br>* Participant will take one or two morphine capsule(s) in the morning and in the evening and one or two placebo double-dummy cebranopadol-like tablet(s) in the morning.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Average Amount of Daily Rescue Medication at the End of the Maintenance Period (Per Protocol Set) | Morphine sulfate immediate release (IR) 10 mg tablets were supplied as rescue medication to trial participants. No dose adjustments of the morphine prolonged release or cebranopadol were allowed during the maintenance period. The daily use of morphine sulfate 10 mg IR tablets was documented by each participant in the trial. The total daily amount of morphine IR was subject to an upper limit recommendation. The primary endpoint is the average amount of daily rescue medication intake over the last 2 weeks of the maintenance period. | The last 2 weeks of the expected 6-week treatment period. | 
| Average Amount of Daily Rescue Medication at the End of the Maintenance Period (Full Analysis Set) | Morphine sulfate IR 10 mg tablets were supplied as rescue medication to trial participants. No dose adjustments of the morphine prolonged release or cebranopadol were allowed during the maintenance period. The daily use of morphine sulfate 10 mg IR tablets was documented by each participant in the trial. The total daily amount of morphine IR was subject to an upper limit recommendation. The primary endpoint is the average amount of daily rescue medication intake over the last 2 weeks of the maintenance period. | The last 2 weeks of the expected 6-week treatment period. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Proportion of Participants With Clinically Relevant Pain Reduction at the End of the Maintenance Period | Each participant indicated the level of pain on an 11-point numerical rating scale (NRS), where a score of 0 indicated no pain and a score of 10 indicated pain as bad as you can imagine. The participants entered their pain intensity in their diary on a daily basis. The pain intensity score in the 2 weeks prior to the final evaluation in the maintenance period was compared with the baseline, the baseline pain intensity was calculated based on the 3 days prior to treatment allocation. The definition of a clinically relevant pain reduction (yes/no) was the presence of at least 1 of the 3 following conditions: Average pain intensity (i.e., average of the 24-hour pain intensities over the last 2 weeks of the Maintenance Phase) of less than 4 points on the 11-point NRS, or Reduction in average pain intensity by at least 30% (compared to the baseline assessment), or Reduction in average pain intensity by at least 2 points (compared to the baseline assessment). | The last 2 weeks of the expected 6-week treatment period. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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cancer pain, neuropathic related cancer pain, morphine, cebranopadol (GRT6005), Numerical Rating Scale