SUZETRIGINE showed limited benefit for cancer-related bone pain in three patients with metastatic spinal disease.
Suzetrigine in Cancer-Related Bone Pain
Cancer-related bone pain remains difficult to manage in patients with advanced metastatic disease, particularly when conventional pharmacologic therapies fail to provide adequate relief. A three-patient case series found no meaningful pain improvement after a three-week trial of suzetrigine, a selective NaV1.8 sodium channel inhibitor, in men with metastatic cancer involving the spine.
All three patients had extensive prior treatment histories and were already receiving opioid therapy. The first patient, a man in his 70s with metastatic prostate cancer involving the spine and ilium, had persistent severe pain despite prior NSAIDs and gabapentinoids. He was taking hydrocodone at approximately 30 morphine milligram equivalents daily. After three weeks of suzetrigine, he reported minimal to no improvement, and treatment was stopped because of lack of efficacy and medication cost.
No Meaningful Pain Reduction Observed
The second patient, a man in his 60s with metastatic lung cancer involving the spine and brain, had severe refractory pain despite NSAIDs, gabapentinoids, and duloxetine. He was receiving a fentanyl patch and hydrocodone totaling approximately 110 morphine milligram equivalents daily. Suzetrigine was added as adjunctive therapy, but no meaningful pain improvement was reported after three weeks. The medication was discontinued, and the patient later transitioned to hospice care as his disease progressed.
The third patient, a man in his 60s with metastatic prostate cancer involving the spine and ilium, had chronic pain refractory to NSAIDs and gabapentinoids. He was receiving acetaminophen-codeine at approximately 45 morphine milligram equivalents daily. After three weeks of suzetrigine, he reported only minimal improvement and chose to stop therapy.
Clinical Implications for Advanced Metastatic Pain
No adverse effects or tolerability issues were reported across the case series, supporting a favorable short-term safety profile. However, tolerability did not translate into clinical benefit for these patients with severe cancer-related bone pain.
The findings suggest that NaV1.8 inhibition may be insufficient for advanced metastatic bone pain, which can involve inflammatory cytokines, osteolytic activity, nerve compression, and central sensitization. The report also highlights potential limitations in opioid-tolerant patients and notes that rapid disease progression may reduce the opportunity to observe benefit from newer non-opioid analgesics.
The authors called for larger randomized trials in cancer-related pain populations, particularly to clarify whether earlier-stage disease, different dosing, or opioid-naïve populations may show greater benefit.
Reference
Hasoon J et al. Suzetrigine for Cancer-Related Bone Pain: A Three-Patient Case Series. Orthopedic Reviews. 2026;18. doi:10.52965/001c.162158.
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