Herbal Treatment to Improve Chemotherapy Delivery

Colon Cancer Clinical Trial

— HATCHED  

Official title:

Effect of TCM-TSKSR on Completion Rates of Chemotherapy in Patients With Stage II & III Colon Cancer: A Randomized Placebo-Controlled Clinical Trial

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT03716518
• Other study ID #: 2017YFC1700604
• Status: Recruiting
• Phase: Phase 3
• Start date: December 12, 2018
• Est. completion date: May 31, 2021

Study information

• Verified date: November 2020
• Source: Xiyuan Hospital of China Academy of Chinese Medical Sciences
• Contact: Yufei Yang, M.D.
• Phone: 8613701366913
• Email: yyfwdbwyy[@]126.com
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This study is designed to:(1) determine the efficacy of Traditional Chinese Medicine (TCM) 'Tonifying Spleen and Kidney Sequential Regimen' (TSKSR) in improving the completion rate of 8-cycle CapeOX chemotherapy in patients with stage II (high-risk)& III colon cancer;(2) evaluate the efficacy of the TCM-TSKSR on adverse events of CapeOX chemotherapy and it's impact on patients' quality of life (QoL).A randomized,double-blinded,placebo-controlled clinical trial including seven centers will be conducted in Mainland China.The study will enroll patients with stage II (high-risk)& III colon cancer who have completed radical surgery and are going to receive CapeOX chemotherapy.All participants will receive chemotherapy as prescribed by their treating physicians and be randomly assigned to either concurrent use of TCM-TSKSR or placebo.

Description:

CapeOX chemotherapy is a combination therapy of Oxaliplatin 130mg/m^2 IV on 1st day and Capecitabine 1000mg/m^2 PO twice daily from 1th day to 14th day,21 days for each course of treatment.Adverse effects of chemotherapy,such as myelosuppression and gastrointestinal reactions,may lead to dose reductions,treatment delays or even discontinuation among cancer patients. According to IDEA study,the completion rate of 8-cycle CapeOX chemotherapy in colorectal cancer patients is 64%,which means that nearly 4 in 10 patients could not complete adjuvant chemotherapy as planned,which may negatively impact patients' survival outcomes.Some prior studies have shown that TCM can improve patients' symptom control and QoL during adjuvant chemotherapy,which may further improve the completion of adjuvant chemotherapy. However,there is a lack of definitive evidence to evaluate the effects of TCM in stage II(high-risk)& III colon cancer patients who receive adjuvant chemotherapy after radical surgery.The study will be conducted between 2018 and 2021.Four hundred participants will be enrolled and randomly assigned to either the experimental group or the control group.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 400
• Est. completion date: May 31, 2021
• Est. primary completion date: May 31, 2021
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 75 Years

Eligibility

Inclusion Criteria:

• Patient with pathological diagnosis of colon cancer; no residual tumor at the resection margin.
• tumor-node-metastasis(TNM)Stage II (high-risk)or III colon cancer according to 8th edition of American Joint Committee on Cancer(AJCC)Staging Manual. High-risk stage II

disease is characterized by at least one of the following:

1. T4 tumor,

2. inadequately sampled nodes (<12 lymph nodes),

3. clinical presentation with bowel obstruction or perforation,

4. poorly differentiated histology ,exclusive of those cancers that are High degree of microsatellite instability(MSI-H),

5. lymphovascular invasion,perineural invasion(PNI).

• Underwent radical surgery no more than six weeks ago and plan to start chemotherapy.
• Have not been enrolled in other therapeutic clinical trials within the near 30 days.
• Age between 18 to 75 years; All genders; Eastern Cooperative Oncology Group - performance status(ECOG-PS)from 0 to 2; Women who are pregnant, lactating or of reproductive age are not eligible, while those of reproductive age using secure contraceptives are eligible.
• No history of previous malignancy other than adequately treated in situ carcinoma of the uterine cervix or basal or squamous cell carcinoma of the skin, unless there has been a disease-free interval of at least 5 years.
• Laboratory testing: blood routine examination:

WBC=3.5×109/L,NEUT=1.5×109/L,PLT=100×109/L,HGB=90g/L;biochemical tests:TBIL=1.5×ULN,AST(SGOT),ALT(SGPT)=2.5×ULN,Scr=1.5×ULN;CEA after surgery was normal.

• Consented.
• Agree not to be enrolled in other interventional studies during the research.

Exclusion Criteria:

• Patients not suitable for chemotherapy of CapeOX ,which will be determined by the investigator or the attending physician.
• Clinically relevant cardiovascular and/or cerebrovascular disease,active hepatitis,severe abnormalities in liver/ renal function tests.
• Known allergy to any of the components of study drug.
• Those who cannot take the study drug orally because of bowel obstruction and/or require for peripheral vein nutrition.
• Malabsorption or diseases that affect the absorption.
• Unstable situations or situations that may endanger the safety of patients and their compliance, such as severe mental illness,schizophrenia.
• Colostomy

Related Conditions & MeSH terms

• Colon Cancer
• Colonic Neoplasms

Intervention

Drug:
• Tonifying Spleen and Kidney Sequential Regimen
TSKSR will be given to the participants as follows:Liu-jun-an-wei Granule,1 pack each time,twice a day,PO,from 0 to 6th day of chemotherapy and Qi-tu-er-zhi Granule,1 pack each time,twice a day,PO,from 7th to 20th day of chemotherapy.
• Placebo of 'Tonifying Spleen and Kidney Sequential Regimen
Placebo of TCM-TSKSR will be given to the participants as follows:placebo of Liu-jun-an-wei Granule,1 pack each time,twice a day,PO,from 0 to 6th day of chemotherapy and placebo of Qi-tu-er-zhi Granule,1 pack each time,twice a day,from 7th to 20th day of chemotherapy.

Locations

Country	Name	City	State
China	Beijing Cancer Hospital	Beijing	Beijing
China	Beijing Chao Yang Hospital	Beijing	Beijing
China	Civil Aviation General Hospital	Beijing	Beijing
China	Oncology Department of Xiyuan Hospital of China Academy of Chinese Medical Sciences	Beijing	Beijing
China	Chongqing University Cancer Hospital	Chongqing	Chongqing
China	Guangdong Provincial Hospital of Traditional Chinese Medicine	Guangdong	Guangzhou
China	Jiangsu Province Hospital of Traditional Chinese Medicine	Nanjing	Jiangsu
China	Shanghai Zhongshan Hospital	Shanghai	Shanghai
China	Tianjin Union Medical Center	Tianjin	Tianjin
China	Henan Provincial People's Hospital	Zhengzhou	Henan
China	The Third People's Hospital of Zhengzhou	Zhengzhou	Henan
China	Zhengzhou Hospital of Traditional Chinese Medicine	Zhengzhou	Henan

Sponsors (13)

Lead Sponsor

Collaborator

Xiyuan Hospital of China Academy of Chinese Medical Sciences

Beijing Cancer Hospital, Beijing Chao Yang Hospital, Beijing University of Chinese Medicine, Chongqing University Cancer Hospital, Civil Aviation General Hospital, Guangdong Provincial Hospital of Traditional Chinese Medicine, Henan Provincial People's Hospital, Jiangsu Province Hospital of Traditional Chinese Medicine, Peking University Third Hospital, Shanghai Zhongshan Hospital, Tianjin Union Medical Center, Zhengzhou Hospital of Traditional Chinese Medicine

Country where clinical trial is conducted

China, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Completion Rate of 8-cycle Adjuvant Chemotherapy	Completion Rate of 8-cycle Adjuvant Chemotherapy=number of participants completing 8-cycle adjuvant chemotherapy/number of participants randomized to each group*100%	6months
Secondary	Completion Rate of Adjuvant Chemotherapy of Each Participant	Completion Rate of Adjuvant Chemotherapy of Each Participant=number of the last courses of chemotherapy/8*100%	6months
Secondary	Completion Rate of 4-cycle Adjuvant Chemotherapy	Completion Rate of 4-cycle Adjuvant Chemotherapy=number of participants completing 4-cycle adjuvant chemotherapy/number of participants randomized to each group*100%	3months
Secondary	Time to Treatment Failure,TTF	TTF is the period from randomization to the earliest day of an event such as withdrawal from protocol treatment for any reasons, patients refusal and loss to follow-up.	6months
Secondary	Relative Dose Intensity (RDI) of Adjuvant Chemotherapy	Relative dose intensity (RDI) (%) = (actual dose/ initial dose of adjuvant chemotherapy) × 100%	6months
Secondary	Proportion of Modifications of Time	Proportion of Modifications of Time=number of participants delaying chemotherapy /number of participants randomized to each group*100%.Delay is defined as =7days because of adverse event,such as weakness, myelosuppression, gastrointestinal reactions and other toxicity,except for administrative issues related to hospitalization.	6months
Secondary	Time of Dose Reductions of Adjuvant Chemotherapy for the First Time	It is the period from randomization to when a chemo-induced grade 3-4 granulocytopenia and/or a chemo-induced grade 2 thrombocytopenia is observed in participants for the first time,in which case,the dose of both Oxaliplatin and Capecitabine will be reduced by 25% of planned dosage.	6months
Secondary	Time of Dose Reductions of Adjuvant Chemotherapy for the Second Time	It is the period from randomization to when a chemo-induced grade 3-4 granulocytopenia and/or a chemo-induced grade 2 thrombocytopenia is observed in participants for the second time,in which case,the dose of both Oxaliplatin and Capecitabine will be reduced by 50% of planned dosage.	6months
Secondary	Proportion of Salvage Treatment	Proportion of Salvage Treatment=Number of participants receiving salvage treatment/Number of participants randomized to each group*100%.	6months
Secondary	Incidence of a Chemo-induced Grade 3-4 Nausea/Vomiting		6 months
Secondary	Incidence of a Chemo-induced Grade 2 Diarrhea		6 months
Secondary	Changes of Participants' ESAS Score	Edmonton Symptom Assessment Scale(ESAS) score will be used to evaluate the change of participants' QoL during adjuvant chemotherapy.ESAS has 9 items designed to assess the severity of commonly reported symptoms experienced by cancer patients,including pain, fatigue, drowsiness, nausea, dyspnea, depression, anxiety, well-being, and loss of appetite.Each items ranges from 0 to 10.	6 months
Secondary	Changes of Participants' FACT-C Score	Functional Assessment of Cancer Therapy-Colorectal (FACT-C) score will be used to evaluate the change of participants' QoL during adjuvant chemotherapy.The FACT-C consists of 36 items,in four domains of well-being (physical,emotional,social,and functional),on a scale of 0 to 4.	6months
Secondary	Changes of TCM Symptoms Score	Based on a prior expert consensus,11 TCM symptoms were considered to be the most common symptoms during CapeOX chemotherapy,including vomiting, numbness, diarrhea, constipation, sensation of chill, nocturia, forgetfulness, spontaneous sweating, night sweats, dry mouth and canker sores, each of which ranges from 0 to 10.	6months
Secondary	Changes of Spleen Deficiency Scale Score	Based on prior researches,the investigator designed Spleen Deficiency Scale,which includes 8 items involving appetite,abdominal distension and so on.Each question ranges from 1 to 5.	6months
Secondary	Changes of Kidney Deficiency Scale Score	Based on prior researches,the investigator designed Kidney Deficiency Scale, which includes 8 items involving soreness of waist, tinnitus, and so on. Each question ranged from 1 to 5.	6months
Secondary	Incidence of AEs	Adverse effects(AEs) includes abnormal results of blood/urine/stool routine examination, liver/renal function test and electrocardiograms.	6months
Secondary	Incidence of SAEs	Serious Adverse effects(SAEs) includes abnormal results of blood/urine/stool routine examination, liver/renal function test and electrocardiograms.	6months