Netupitant/Palonosetron Hydrochloride and Dexamethasone with or without Prochlorperazine or Olanzapine in Improving Chemotherapy-Induced Nausea and Vomiting in Patients with Breast Cancer
This randomized phase III trial studies how well netupitant/palonosetron hydrochloride and dexamethasone with or without prochlorperazine or olanzapine work in improving chemotherapy-induced nausea and vomiting in patients with breast cancer. Antiemetic drugs, such as prochlorperazine and olanzapine, may help lessen nausea and vomiting in patients with breast cancer treated with chemotherapy.
Inclusion Criteria
- INCLUSION CRITERIA FOR PARTICIPATION IN THE CYCLE 1 PORTION OF THE STUDY
- Have a diagnosis of breast cancer and be chemotherapy naive; NOTE: prior methotrexate for non-cancerous conditions is allowed
- Be scheduled to receive a single-day chemotherapy regimen that contains doxorubicin and/or cyclophosphamide and/or carboplatin; Herceptin (trastuzumab) and other chemotherapy agents will be allowed with any of these regimens
- Be scheduled to receive an antiemetic regimen that does not contain Akynzeo * For chemotherapy regimens with a high emetic risk, the antiemetic regimen must include an natural killer (NK)-1 antagonist receptor, a 5HT3 receptor antagonist and dexamethasone; other antiemetics, including additional dexamethasone and olanzapine, may also be included at cycle one * For chemotherapy regimens with a moderate emetic risk, the antiemetic regimen must include a 5HT3 receptor antagonist and dexamethasone; other antiemetics, including additional dexamethasone and olanzapine, may also be included at cycle one
- Be able to read English; materials will not be provided in Spanish because validated translations of most of the study measures are not available in Spanish, and Spanish translating capacity is not available at all affiliate sites
- Have the ability to give written informed consent
- Be at least 18 years of age
- Be female
- Have Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2
- NOTE: Because the National Comprehensive Cancer Network (NCCN) antiemetic guidelines state that olanzapine should be used with caution in elderly patients, patients 80 years of age or older must have approval from an oncologist or their designee to participate in this study
- NOTE: Because aprepitant can lower international normalized ratio (INR) levels if taken concurrently with warfarin, patients currently receiving warfarin must have approval from an oncologist or their designee to participate in this study.
- Women of child-bearing potential must agree to use adequate contraception (hormonal or barrier method of birth control, or abstinence) for the duration of the study and have a negative pregnancy test within 10 days prior to the initiation of chemotherapy; should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her study physician immediately
- CYCLE II PORTION ONLY: Only participants with a nausea score >= 3 at least once on the 4-day home record from cycle 1 can be randomized for cycle 2
- CYCLE II PORTION ONLY: Participants must be scheduled to receive the same chemotherapy regimen as received at cycle 1
- CYCLE II PORTION ONLY: Because quinolone antibiotic therapy can increase the level or effect of olanzapine by altering drug metabolism and thereby potentially increase risk of side effects, patients currently receiving quinolone antibiotic therapy must have approval from an oncologist or their designee to participate in the cycle 2 portion of the study
Exclusion Criteria
- PARTICIPATION IN THE CYCLE I PORTION OF THE STUDY
- Have clinical evidence of current or impending bowel obstruction
- Have a known history of central nervous system disease (e.g., brain metastases or a seizure disorder)
- Have dementia
- Have uncontrolled diabetes mellitus or uncontrolled hyperglycemia
- Have severe hepatic impairment, severe renal impairment, or end-stage renal disease as determined by the treating physician
- Have had long-term treatment (> 5 days within the past 30 days) with an antipsychotic agent such as risperidone, quetiapine, clozapine, a phenothiazine, or a butyrophenone within 30 days before enrollment or plans for such treatment during the study period; Note: Participants could have received prochlorperazine and other phenothiazines as antiemetic therapy on a short term basis (i.e., =< 5 days)
- Have a known cardiac arrhythmia, uncontrolled congestive heart failure, or acute myocardial infarction within the previous 6 months
- Be taking benzodiazepines regularly (> 5 days within the past 30 days); pro re nata (PRN) use (=< 5 days) for the short-term relief of the symptoms of anxiety, anxiety associated with depressive symptoms, or as a rescue medication for breakthrough CINV is allowed
- Be taking anticholinergic medications
- Be receiving quinolone antibiotic therapy
- Be taking amifostine (Ethiofos)
- Have a known hypersensitivity to olanzapine or to phenothiazines
- CYCLE II PORTION ONLY: Must not have received Akynzeo at cycle 1
- CYCLE II PORTION ONLY: Must still meet all the exclusion criteria for cycle 1
Study sponsor and potential other locations can be found on ClinicalTrials.gov for NCT03367572.
PRIMARY OBJECTIVE:
I. To determine if control of nausea at cycle 2 in participants who experienced chemotherapy-induced nausea and vomiting (CINV) at cycle 1 is improved by the addition of either prochlorperazine or olanzapine to the control arm of netupitant, palonosetron and dexamethasone.
SECONDARY OBJECTIVES:
I. To determine if olanzapine is more effective than prochlorperazine in controlling nausea at cycle 2 in participants who experienced CINV at cycle 1 when used in combination with netupitant, palonosetron and dexamethasone.
II. To determine if control of vomiting at cycle 2 in patients who experienced CINV at cycle 1 is improved by the addition of either prochlorperazine or olanzapine to the control arm of netupitant, palonosetron and dexamethasone.
III. To determine if olanzapine is more effective than prochlorperazine in controlling vomiting at cycle 2 in participants who experienced CINV at cycle 1 when used in combination with netupitant, palonosetron and dexamethasone.
EXPLORATORY OBJECTIVES:
I. To create an empirically-based algorithm predicting nausea from breast cancer chemotherapy regimens that takes into account not only state-of-the-art anti-emetic regimens but also participant factors such as age, race, education, ethnicity, quality of life (QOL), alcohol consumption, susceptibility to nausea, expectancy, anxiety, level of nausea on the day prior to treatment, and prior history of nausea.
II. To compare the effects of the interventions on QOL, as assessed by the Functional Assessment of Cancer Therapy- General (FACT-G), by following the same procedures described under the primary aim and the first secondary aim, using change in the FACT-G scores as the response.
III. To provide preliminary data on the frequency and severity of sleep disturbance, fatigue, anxiety, and dizziness, across treatment conditions.
IV. To provide preliminary data on biological factors (e.g. glutathione [GSH] recycling, genetic markers) that may help identify a subgroup of participants at high risk for development of cancer-related or treatment-related side effects, or response to treatment.
OUTLINE:
PART I: Patients receive 1 cycle of standard of care chemotherapy.
PART II: Patients with a nausea score >= 3 at least once on the diary at cycle 1 chemotherapy are randomized into 1 of 3 groups at cycle 2.
GROUP I: Within 1 hour prior to chemotherapy, patients receive netupitant/palonosetron hydrochloride orally (PO) on day 1. Within 30 minutes prior to chemotherapy, patients also receive dexamethasone PO on days 1-4. Patients also receive placebo PO with chemotherapy every 8 hours (Q8H) on days 1-4.
GROUP II: Patients receive netupitant/palonosetron hydrochloride and dexamethasone as in Group I. Patients also receive prochlorperazine PO Q8H and placebo PO with chemotherapy on days 1-4.
GROUP III: Patients receive netupitant/palonosetron hydrochloride and dexamethasone as in Group I. Patients also receive olanzapine PO and placebo PO Q8H with chemotherapy on days 1-4.
Patients undergo blood sample collection at screening.
Trial PhasePhase III
Trial Typesupportive care
Lead OrganizationUniversity of Rochester NCORP Research Base
Principal InvestigatorLuke Joseph Peppone
- Primary IDURCC16070
- Secondary IDsNCI-2017-00902, URCC-16070
- ClinicalTrials.gov IDNCT03367572