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Cleveland improved to 4-1 by outscoring a watered-down San Antonio roster 56-39 in the second half, including an 11-2 run late in the third quarter of the game at the University of Pittsburgh's Petersen Events Center.
Gary Neal had 10 points and former Pitt star and Pittsburgh native DeJuan Blair nine points and 11 rebounds for the Spurs (2-2).
The Spurs had played two days earlier in Mexico City, a 100-99 win over the Los Angeles Clippers. None of the team's "Big Three" stars -- Tim Duncan, Manu Ginobili and Tony Parker -- made the trip, and neither did veteran starter Richard Jefferson.
But many of the announced crowd of 5,121 - less than a half of capacity - came to see Blair, who starred for two years at Pitt after playing his high school ball a few blocks away.
Ramon Sessions added 14 points and nine rebounds, and Daniel Gibson had 13 points, six assists and four rebounds for Cleveland.
Among Cavs regulars who did not play were guard Mo Williams (groin) and swingman Anderson Varejao, who is recovering from an ankle injury and had previously missed nine days of camp to attend his grandfather's funeral.
Forward Antawn Jamison did not play after sustaining a left knee sprain in the second quarter. The injury is not expected to be serious. Guard Anthony Parker also had a minor hand injury during the game.
Hickson, a 6-9 third-year forward, has been Cleveland's leading scorer and rebounder this preseason following the much-publicized departure of LeBron James.