Electroacupuncture for the Prevention of Chemotherapy-induced Nausea and Vomiting in Patients With Breast Cancer

Jiuda Zhao

Status and phase: Enrolling; Phase 3

Conditions: Nausea and Vomiting; Olanzapine-contained Four-drug Antiemetic; Electroacupuncture

Treatments: Drug: Standard antiemetic treatment; Device: Electroacupuncture; Device: Sham electroacupuncture

Study type: Interventional

Funder types: Other

Identifiers

NCT06200168

AHQU-2023002

Details and patient eligibility

About

This randomized controlled phase III trial aims to evaluate the use of electroacupuncture in combination with olanzapine-containing standard quadruple antiemetic drugs for the treatment of nausea and vomiting induced by highly emetogenic chemotherapy (HEC) in patients with breast cancer. Furthermore, it will analyze the relationship between single nucleotide polymorphism and electroacupuncture treatment for chemotherapy-induced nausea and vomiting.

Full description

This study is a parallel-group, blinded (participants, evaluators, and statisticians), randomized controlled trial exploring the effectiveness of electroacupuncture combined with standard quadruple antiemetic drugs for breast cancer patients undergoing HEC. Both groups will receive Olanzapine, Neurokinin-1 receptor antagonists (NK-1RAs), serotonin receptor antagonists [5HT3RA], and dexamethasone at the start of HEC on Day 1. Electroacupuncture or sham acupuncture will be randomly administered to each group. Participants will document all instances of nausea and vomiting and note the use of rescue antiemetic medications. Blood samples will be collected and analyzed to investigate whether genetic polymorphisms can predict electroacupuncture outcomes in breast cancer patients undergoing HEC. Primary and secondary outcomes as well as adverse events will be assessed.

Enrollment: 370 estimated patients

Sex: All

Ages: 18 to 75 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

1. Aged 18 years or older and aged 75 years or younger, of any nationality;
2. Eastern Cooperative Oncology Group performance status of 0-2;
3. Patients with breast cancer, with no restrictions on molecular typing; early-stage patients must not have undergone prior chemotherapy, while advanced-stage patients must be candidates for first-line chemotherapy and have declined neoadjuvant or adjuvant chemotherapy for over 3 months. All patients must receive highly emetogenic chemotherapy (HEC) based on anthracycline chemotherapy with cyclophosphamide (EC or AC) or carboplatin (AUC≥4)/cisplatin;
4. Predicted life expectancy of ≥3 months;
5. Adequate bone marrow, kidney, and liver function;
6. Adequate contraception if premenopausal women;
7. Written informed consent by the patient before enrolment.

Exclusion criteria

1. Patients already submitted to chemotherapy;
2. Is scheduled to receive any non-HEC on Day 1;
3. Is scheduled to receive any chemotherapy on days 2-4 after HEC;
4. Received or is scheduled to receive radiation therapy to the abdomen, pelvis, head and neck within 1 week prior to Day 1 or between Days 1 to 5 in cycle 1;
5. Has symptomatic primary or metastatic symptomatic central nervous system malignancy causing nausea and/or vomiting;
6. Have ongoing emesis or CTCAE grade 2 or greater nausea;
7. Significant medical or mental conditions;
8. Any allergies to study drug, antiemetics or dexamethasone;
9. Significantly abnormal laboratory values (platelets, coagulation indexes, absolute neutrophils, AST, ALT, bilirubin or creatinine);
10. Patients who are pregnant or breast-feeding;
11. Inflammatory skin reaction;
12. Has lymphedema in acupuncture stimulation area;
13. Patients who are afraid of electroacupuncture stimulation or allergic to stainless steel needles;
14. Received acupuncture treatments for any conditions less than 4 weeks before HEC;
15. Currently using drugs with antiemetic activity (e.g., 5-HT3 receptor antagonists, corticosteroids (except when used at physiological doses), dopamine receptor antagonists, minor tranquilizers, antihistamines, and benzodiazepines (except for nocturnal sedation));
16. Patients with concomitant severe diseases or with a predisposition to emesis such as gastrointestinal obstruction, active peptic ulcer, and hypercalcemia and symptomatic brain metastasis;
17. Has a convulsive disorder requiring anticonvulsant treatment;
18. Patients administered thioridazine as a chronic antipsychotic medication (patients are allowed to receive prochlorperazine and other phenothiazines as a rescue antiemetic treatment);
19. Concurrent treatment with quinolone antibiotics;
20. Has a history of chronic alcoholism (determined by the investigator);
21. Known arrhythmias, uncontrolled congestive heart failure, or acute myocardial infarction within the past six months;
22. Has a history of uncontrolled diabetes (e.g., using insulin or oral hypoglycemic agents).

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Triple Blind

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370 participants in 2 patient groups, including a placebo group

True acupuncture + standard quadruple antiemetic therapy

Experimental group

Description:

Participants will receive electroacupuncture once daily from day 1 to day 4. The acupuncturists will insert needles into the acupoints and manipulate the needles until"de qi"sensation is achieved and reported by the participants. Electrical stimulation will be delivered for 30 minutes at alternating frequencies of 2/10Hz. They will receive olanzapine 2.5 mg per day orally on days 1 through 4 + fosaprepitant 150 mg intravenous (IV) or aprepitant injectable emulsion 130 mg IV + palonosetron 0.25 mg IV or ondansetron 8 mg IV (the previously mentioned medication, which includes fosaprepitant or aprepitant combined with palonosetron or ondansetron, can also be taken orally in a fixed combination of netupitant (300 mg) and palonosetron (0.50 mg))+ dexamethasone 10 mg IV 30 minutes prior to chemotherapy on Day 1, dexamethasone 8 mg IV on days 2, 3, 4 post chemotherapy. Dexamethasone doses may be individualized based on the doctor's judgment.

Treatment:

Device: Electroacupuncture

Drug: Standard antiemetic treatment

Sham acupuncture + standard quadruple antiemetic therapy

Placebo Comparator group

Description:

The sham acupuncture comprised a core standardized prescription of minimally invasive, shallow needle insertion using thin and short needles at body locations not recognized as true acupuncture points and are deemed to not belong to traditional Chinese meridians and have no therapeutic value. Participants will receive minimal acupuncture treatment without electrical stimulation at the same time as the intervention group.Care was taken to avoid "de qi" sensation. They will receive olanzapine-contained four-drug antiemetic therapy. All the antiemetic drugs used are the same as those in the true acupuncture group.

Treatment:

Device: Sham electroacupuncture

Drug: Standard antiemetic treatment