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Oral Akynzeo® vs Standard of Care in Preventing CINV in High-risk MEC Patients (MyRisk) (CINV)

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ClinicalTrials.gov Identifier: NCT04817189
Recruitment Status : Recruiting
First Posted : March 26, 2021
Last Update Posted : November 9, 2022
Sponsor:
Information provided by (Responsible Party):
Helsinn Healthcare SA

Brief Summary:

MyRisk: Efficacy and safety evaluation of oral Akynzeo® in patients receiving MEC at high risk of developing CINV based on a prediction tool. A multinational and multicenter study.

Antiemetic guidelines recommendations are based on the emetogenic potential of the chemotherapy. Chemotherapy (CT) agents are divided in Highly, Moderately, Low and Minimally Emetogenic potential.

In addition to type of chemotherapy, several patient-related risk factors can increase the risk of CINV (chemotherapy-induced nausea and vomiting). Currently, there is limited consensus surrounding the most relevant patient risk factors that may predict the risk of CINV. Based on a recent study by Dranitsaris et al. (Dranitsaris et al. Ann Oncol. 2017 Jun 1; 28(6):1260-1267.), eight (8) predictive factors have been identified and an algorithm has been developed to incorporate these factors into the optimal selection of prophylactic antiemetics:

  1. nausea and/or vomiting in the prior cycle of chemotherapy
  2. use of non-prescribed antiemetics at home in the prior cycle of chemotherapy
  3. platinum or anthracycline-based chemotherapy
  4. age < 60 years
  5. expectations for (anticipating) nausea and/or vomiting
  6. <7 h of sleep the night before chemotherapy
  7. history of morning sickness during previous pregnancy
  8. cycle of chemotherapy (A negative association between risk and number of cycles was identified where the hazard for CINV was highest in cycles 1 and 2, with a gradual decline and plateau from cycle 3 onward).

The clinical application of this prediction tool has the potential to be an important resource for clinicians and may help to enhance patient care by optimizing the use of the antiemetics in a proactive manner.


Condition or disease Intervention/treatment Phase
Chemotherapy-induced Nausea and Vomiting Drug: NEPA (300mg netupitant/0.5mg palonosetron) Drug: Granisetron, 2 mg (oral) or 1 mg (IV) OR Palonosetron, 0.5 mg (oral), 0.25mg (IV) OR Ondansetron, 16 mg (oral) or 8 mg (IV) OR Dolasetron 100 mg (oral) OR Tropisetron 5 mg (oral or IV) Drug: Dexamethasone, 8 mg (oral) or equivalent IV dose Phase 4

Detailed Description:

Antiemetic guideline recommendations are based on the emetogenic potential of chemotherapy and involve 4 levels of classification of intravenous chemotherapy agents, i.e., high, moderate, low and minimal; these have been accepted by major organisations. Moderate emetogenic chemotherapy (MEC) results in acute vomiting in 30% to 90% of cancer patients in the absence of antiemetic therapy. In addition to the chemotherapy type, several patient-related risk factors and clinical characteristics can increase CINV risk. These can include use of antiemetics inconsistent with international guidelines, younger age, prechemotherapy nausea, no complete CINV response in an earlier cycle, history of nausea/vomiting, (trait) anxiety, fatigue experience, and expectations of nausea/vomiting. Other studies have largely confirmed some of the key risk factors for CINV (history of vomiting during pregnancy, history of motion sickness, age, gender) and added other factors such as (chronic) alcohol consumption, body surface area, fewer hours slept the night prior to infusion, or advanced stage cancer. Currently, there is a limited consensus surrounding the most relevant patient risk factors that may predict CINV risk. Based on a recent study by Dranitsaris et al. eight predictive factors have been identified, and an algorithm has been developed to combine these patient-related risk factors into the optimal treatment of prophylactic antiemetics. These include:

  1. nausea and/or vomiting in the prior cycle of chemotherapy
  2. use of non-prescribed antiemetics at home in the prior cycle of chemotherapy
  3. platinum or anthracycline-based chemotherapy
  4. age < 60 years
  5. expectations for (anticipating) nausea and/or vomiting
  6. <7 h of sleep the night before chemotherapy
  7. history of morning sickness during previous pregnancy
  8. cycle of chemotherapy (A negative association between risk and number of cycles was identified where the hazard for CINV was highest in cycles 1 and 2, with a gradual decline and plateau from cycle 3 onward).

Akynzeo®, an oral combination of the neurokinin 1 receptor antagonists (NK1 RA), netupitant and the 5-hydroxytryptamine (HT3) receptor antagonists (5-HT3 RA), palonosetron, is recommended by guidelines for the prevention of CINV. Akynzeo® has been evaluated in a multicentre, randomised, double-blind, double-dummy phase II clinical trial at various dose ranges among 694 cisplatin-treated cancer patients from 44 sites (two countries); each NEPA (netupitant-palonosetron) dose significantly improves CINV prevention in cancer patients. Similar results were obtained in another international, randomised, double-blind and parallel group phase III clinical trial; NEPA prevented CINV in patients receiving MEC.

The current study primarily aimed to evaluate whether Akynzeo® leads to a higher response rate compared with standard care in MEC regimen-treated patients who are identified to be at high risk based on the algorithm.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 530 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: interventional, open label, randomized, active controlled, parallel arms, multicenter and multinational study
Masking: None (Open Label)
Primary Purpose: Supportive Care
Official Title: MyRisk: Efficacy and Safety Evaluation of Oral Akynzeo® in Patients Receiving MEC at High Risk of Developing CINV Based on a Prediction Tool: A Multinational and Multicenter Study
Actual Study Start Date : February 1, 2021
Estimated Primary Completion Date : April 30, 2024
Estimated Study Completion Date : November 30, 2024

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: NEPA (300mg netupitant/0.5mg palonosetron) + Dexamethasone 8 mg

Oral netupitant/palonosetron (300 mg/0.50 mg) fixed-dose combination on Day 1 of each cycle.

Dexamethasone (8 mg) will be administered on Day 1 of each cycle.

Drug: NEPA (300mg netupitant/0.5mg palonosetron)
Oral netupitant/palonosetron (300 mg/0.50 mg) fixed-dose combination on Day 1 of each cycle.
Other Name: Akynzeo® capsules

Drug: Dexamethasone, 8 mg (oral) or equivalent IV dose
Dexamethasone (8 mg) will be administered on Day 1 of each cycle.
Other Name: corticosteroid

Active Comparator: Standard of care + Dexamethasone 8 mg

Dexamethasone (or equivalent corticosteroids) 8 mg administered by the oral route (or equivalent IV dose) on Day 1, approximately 1 hour before chemotherapy and one of the 5-HT3-RAs recommended by European Society for Medical Oncology (ESMO) and Multinational Association of Supportive Care in Cancer (MASCC) guidelines (standard of care), i.e. either:

Granisetron, 2 mg (oral) or 1 mg (IV) OR Palonosetron, 0.5 mg (oral), 0.25mg (IV) OR Ondansetron, 16 mg (oral) or 8 mg (IV) OR Dolasetron 100 mg (oral) OR Tropisetron 5 mg (oral or IV)

Drug: Granisetron, 2 mg (oral) or 1 mg (IV) OR Palonosetron, 0.5 mg (oral), 0.25mg (IV) OR Ondansetron, 16 mg (oral) or 8 mg (IV) OR Dolasetron 100 mg (oral) OR Tropisetron 5 mg (oral or IV)
Standard of care will be administered on Day 1 of each cycle.
Other Name: 5-HT3 RA

Drug: Dexamethasone, 8 mg (oral) or equivalent IV dose
Dexamethasone (8 mg) will be administered on Day 1 of each cycle.
Other Name: corticosteroid




Primary Outcome Measures :
  1. The proportion of complete responses over three cycles of chemotherapy after the start of the MEC administration [ Time Frame: At the end of all three chemotherapy cycles. The length of a cycle depends on the treatment being given (cycles range from 2 to 6 weeks). ]
    To evaluate if the use of NEPA (netupitant and palonosetron) in patients treated with IV moderately emetogenic chemotherapy and at high risk of CINV is more effective in preventing CINV than a standard of care antiemetics over three cycles of chemotherapy.


Secondary Outcome Measures :
  1. Evaluation of acute (0 to 24 hours), delayed (>24 to 120 hours), and overall (0-120 hours) CINV indicators in each cycle of chemotherapy [ Time Frame: At the end of each cycle and after all 3 chemotherapy cycles. The length of a cycle depends on the treatment being given (cycles range from 2 to 6 weeks). ]

    Proportion of:

    • No emetic episode during the acute, delayed, and overall phase and daily in each cycle
    • Number of vomiting episodes during the acute, delayed, and overall phase in each cycle
    • No rescue medication during the acute, delayed, and overall phase and daily in each cycle
    • No significant nausea (maximum MAT scale = 2) during the acute, delayed, and overall phase and daily in each cycle;
    • No nausea (MAT scale = 0) during the acute, delayed, and overall phase and daily in each cycle;
    • Complete protection (no emetic episode, no rescue medication, and no significant nausea) during the acute, delayed, and overall phase and daily in each cycle

    Time 0 is defined as the start time of the chemotherapy administration on Day 1 of each of the three cycles.


  2. Evaluation of the predictive role of potential risk factors in the development of CINV over three cycles of chemotherapy [ Time Frame: At the end of each cycle and after all 3 chemotherapy cycles. The length of a cycle depends on the treatment being given (cycles range from 2 to 6 weeks). ]

    Analysis of the development of CINV as a dependent variable will be performed to identify additional potential risk factors of CINV thought to be increasing the risk of CINV in patients receiving MEC.

    The outcome measure is the development of CINV, defined as any occurrence of nausea or a vomiting episode.

    The data on the development of CINV will be taken from data collection tools, patients' diaries and MASCC Antiemesis Tool (MAT).


  3. Evaluation of the safety profile of the antiemetic drug over three cycles of chemotherapy - the frequency of adverse events (AE) [ Time Frame: At the end of all 3 chemotherapy cycles. The length of a cycle depends on the treatment being given (cycles range from 2 to 6 weeks). ]

    An overall summary of adverse events (AE) will be presented, including the frequency of patients with:

    • Any treatment-emergent adverse event
    • Any treatment-emergent adverse event related to a study drug
    • Any treatment-emergent adverse event leading to chemotherapy dose reductions or interruptions
    • Any treatment-emergent serious adverse event

    All AEs will be summarized by their:

    • Severity
    • Seriousness
    • Relationship to a drug

  4. Evaluation of the safety profile of the antiemetic drug over three cycles of chemotherapy - the percentage of adverse events (AE) [ Time Frame: At the end of all 3 chemotherapy cycles. The length of a cycle depends on the treatment being given (cycles range from 2 to 6 weeks). ]

    An overall summary of adverse events (AE) will be presented, including the percentage of patients with:

    • Any treatment-emergent adverse event
    • Any treatment-emergent adverse event related to a study drug
    • Any treatment-emergent adverse event leading to chemotherapy dose reductions or interruptions
    • Any treatment-emergent serious adverse event

    All AEs will be summarized by their:

    • Severity
    • Seriousness
    • Relationship to a drug

  5. Evaluation of the frequency of discontinuations due to adverse events [ Time Frame: At the end of all 3 chemotherapy cycles. The length of a cycle depends on the treatment being given (cycles range from 2 to 6 weeks). ]

    The frequency of discontinuations due to adverse events (AE) will be presented.

    All AEs leading to discontinuation will be summarized by their:

    • Severity
    • Seriousness
    • Relationship to a drug

  6. Evaluation of the percentage of discontinuations due to adverse events [ Time Frame: At the end of all 3 chemotherapy cycles. The length of a cycle depends on the treatment being given (cycles range from 2 to 6 weeks). ]

    The percentage of patients with discontinuations due to adverse events (AE) will be presented.

    All AEs leading to discontinuation will be summarized by their:

    • Severity
    • Seriousness
    • Relationship to a drug

  7. Evaluation of frequency of on treatment deaths due to adverse events [ Time Frame: At the end of all 3 chemotherapy cycles. The length of a cycle depends on the treatment being given (cycles range from 2 to 6 weeks). ]

    The frequency of on treatment deaths due to adverse events (AE) will be presented.

    All AEs leading to on treatment deaths will be summarized by their:

    • Severity
    • Seriousness
    • Relationship to a drug

  8. Evaluation of the percentage of patients with on treatment death due to adverse events [ Time Frame: At the end of all 3 chemotherapy cycles. The length of a cycle depends on the treatment being given (cycles range from 2 to 6 weeks). ]

    The percentage of patients with on treatment death due to adverse events (AE) will be presented.

    All AEs leading to on treatment death will be summarized by their:

    • Severity
    • Seriousness
    • Relationship to a drug

  9. Listings concerning the safety profile of the antiemetic drug over three cycles of chemotherapy [ Time Frame: At the end of all 3 chemotherapy cycles. The length of a cycle depends on the treatment being given (cycles range from 2 to 6 weeks). ]

    The following listings will be presented:

    • All AEs (including pre-treatment AEs)
    • Serious adverse events
    • Adverse events resulting in withdrawn of study drug

  10. Exploration of the effect of CINV on daily activities and quality of life in patients receiving moderately-emetogenic chemotherapy over three cycles of chemotherapy [ Time Frame: At the end of all 3 chemotherapy cycles. The length of a cycle depends on the treatment being given (cycles range from 2 to 6 weeks). ]

    Evaluation of the effect of CINV on daily activities and quality of life that will be measured by using the Functional Living Index-Emesis (FLIE) questionnaire, a validated, nausea and vomiting specific, patient-reported outcome instrument.

    The Functional Living Index-Emesis (FLIE) has 18 questions. These questions are divided into two domains: Nausea (questions 1-9) and Vomiting (questions 10-18).

    The minimum score for any question is 0 and the maximum score is 100. Higher scores indicate less impairment on daily life as a result of nausea or vomiting.


  11. Evaluation of resource utilization and health economic outcome - number of days with rescue medication administered for the treatment of CINV [ Time Frame: At the end of each cycle and after all 3 chemotherapy cycles. The length of a cycle depends on the treatment being given (cycles range from 2 to 6 weeks). ]
    Health economic endpoint, the number of days with rescue medication administered for the treatment of CINV, will be evaluated during the study cycles

  12. Evaluation of resource utilization and health economic outcome - daily doses of rescue medication administered for the treatment of CINV [ Time Frame: At the end of each cycle and after all 3 chemotherapy cycles. The length of a cycle depends on the treatment being given (cycles range from 2 to 6 weeks). ]
    Health economic endpoint, the daily doses of rescue medication administered for the treatment of CINV, will be evaluated during the study cycles

  13. Evaluation of resource utilization and health economic outcome - the number of re-hydration bags [ Time Frame: At the end of each cycle and after all 3 chemotherapy cycles. The length of a cycle depends on the treatment being given (cycles range from 2 to 6 weeks). ]
    Health economic endpoint, the number of re-hydration bags given for at least grade 2 vomiting (more details below), will be evaluated during the study cycles

  14. Evaluation of resource utilization and health economic outcome - the number of days of unplanned hospitalisations [ Time Frame: At the end of each cycle and after all 3 chemotherapy cycles. The length of a cycle depends on the treatment being given (cycles range from 2 to 6 weeks). ]

    Health economic endpoint, the number of days of unplanned hospitalizations related to CINV, will be evaluated during the study cycles

    All hospitalizations will be summarized according to the department of hospitalization (type of ward)


  15. Evaluation of resource utilization and health economic outcome - the number of outpatient physician visits [ Time Frame: At the end of each cycle and after all 3 chemotherapy cycles. The length of a cycle depends on the treatment being given (cycles range from 2 to 6 weeks). ]
    Health economic endpoint, the number of outpatient physician visits and health care consultations due to CINV (e.g., general practitioner), will be evaluated during the study cycles

  16. Evaluation of resource utilization and health economic outcome - the number of unplanned laboratory test [ Time Frame: At the end of each cycle and after all 3 chemotherapy cycles. The length of a cycle depends on the treatment being given (cycles range from 2 to 6 weeks). ]
    Health economic endpoint, the number of unplanned laboratory test including those at unplanned hospitalizations due to CINV, will be evaluated during the study cycles

  17. Evaluation of resource utilization and health economic outcome - discontinuation of chemotherapy treatment due to CINV [ Time Frame: At the end of each cycle and after all 3 chemotherapy cycles. The length of a cycle depends on the treatment being given (cycles range from 2 to 6 weeks). ]
    Health economic endpoint, the number of discontinuations of chemotherapy treatment due to CINV, will be evaluated during the study cycles

  18. Evaluation of resource utilization and health economic outcome - the number of delays of chemotherapy administration due to CINV [ Time Frame: At the end of each cycle and after all 3 chemotherapy cycles. The length of a cycle depends on the treatment being given (cycles range from 2 to 6 weeks). ]
    Health economic endpoint, the number of delays of chemotherapy administration due to CINV, will be evaluated during the study cycles

  19. Evaluation of resource utilization and health economic outcome - the average length of delay of chemotherapy administration due to CINV [ Time Frame: At the end of each cycle and after all 3 chemotherapy cycles. The length of a cycle depends on the treatment being given (cycles range from 2 to 6 weeks). ]
    Health economic endpoint, the average length of delay (in days) of chemotherapy administration due to CINV, will be evaluated during the study cycles

  20. Evaluation of resource utilization and health economic outcome - days of absence from work [ Time Frame: At the end of each cycle and after all 3 chemotherapy cycles. The length of a cycle depends on the treatment being given (cycles range from 2 to 6 weeks). ]
    Health economic endpoint, the number of days of absence from work, will be evaluated during the study cycles



Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Adult patients aged ≥18 years
  • Patients with a risk score of ≥ 13 as calculated by the algorithm - see 3.6.3.1. Baseline/screening: VISIT 0
  • Signed Informed consent
  • Both sexes
  • Patients with diagnosis of any cancer scheduled and intended to be treated for three consecutive cycles with a single dose of any IV MEC regimen, per cycle, including adjuvant or neo-adjuvant chemotherapy
  • Patients with Eastern Cooperative Oncology Group (ECOG) performance status 0, 1 or 2
  • Use of Standard of Care defined as a 5-HT3 RA + Dexamethasone (or equivalent corticosteroid) based-regimen on day 1 of chemotherapy for CINV prevention
  • Naïve and non- naïve to chemotherapy
  • The enrolled women should be a) of non-childbearing potential or b) of childbearing potential using reliable contraceptive measures and having a negative urine pregnancy test done by health care team within 1-24 hours before dosing the antiemetic treatment in both arms and outcome recorded in the medical records
  • Able to comply with study requirements

Exclusion Criteria:

  • Patients receiving highly emetogenic chemotherapy (including anthracycline+cyclophosphamide-based chemotherapy)
  • Patients receiving oral moderately emetogenic chemotherapy drugs
  • Patients receiving opioids within 2 weeks prior to trial enrollment (longer use allowed)
  • Use of olanzapine as prophylaxis of CINV
  • Patients scheduled to receive radiotherapy concurrently with chemotherapy
  • Any illness or condition that, in the opinion of the physician, may confound the results of the study or pose unwarranted risks in administering the investigational product to the patient.
  • Patients with mechanical risk factors for nausea (i.e. intestinal obstruction)
  • Patients with liver disease (as nausea is a common presenting symptom)
  • Patients with metabolic risk factors for nausea (i.e. electrolyte imbalances causing nausea/vomiting)
  • Chronic treatment with steroids (with the exception of inhaled or topical steroids)
  • Pregnancy and/or breast-feeding women
  • Women of childbearing potential refusing to use effective contraception during the whole study treatment and up to one month after study treatment with Akynzeo®
  • Use of Standard of Care including an NK-1 RA-based regimen to prevent CINV

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04817189


Contacts
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Contact: Alessandro Alonzi, MSc. +41 91 985 18 81 Alessandro.Alonzi@helsinn.com
Contact: Marika Chrápavá, MSc. +420 605 550 715 chrapava@biostatistika.cz

Locations
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Czechia
General University Hospital in Prague Recruiting
Prague, Czechia
Contact: Michaela Čabiňáková, MD, PhD         
Thomayerova nemocnice Recruiting
Praha, Czechia, 14059
Contact: Tomáš Büchler, Assoc.prof.    +420 261 083 530    tomas.buchler@ftn.cz   
Germany
Evang. Kliniken Essen-Mitte Recruiting
Essen, Germany
Contact: Daniel Christoph, doctor         
IKF Frankfurt, Krankenhaus Nordwest GmbH Not yet recruiting
Frankfurt, Germany
Contact: Thorsten Oliver Götze, Doctor         
Universitätsklinikum Heidelberg Recruiting
Heidelberg, Germany
Contact: Juliane Brandt, MD         
Universitätsmedizin Mannheim Recruiting
Mannheim, Germany
Contact: Ralf-Dieter Hofheinz, professor         
München Klinik Neuperlach Recruiting
München, Germany
Contact: Meinolf Karthaus, professor         
Frauenklinik St. Louise Recruiting
Paderborn, Germany
Contact: Michaela Wüllner, Doctor         
Klinikum Ernst von Bergmann gemeinnützige GmbH Recruiting
Potsdam, Germany
Contact: Karin Jordan, prof.         
Greece
Sotiria General Hospital, 3rd Deúpartment of Medicine, School of Medicine, National and Kapodistrian University of Athens Recruiting
Athens, Greece
Contact: Konstantinos Syrigos, Prof.    0030 2107700220    ksyrigos.trials@gmail.com   
General University Hospital of Heraklion Recruiting
Heraklion, Greece
Contact: Dimitris Mavroudis, professor    0030 2810392091    mavroudis@uoc.gr   
Switzerland
University Hospital Basel Recruiting
Basel, Switzerland
Contact: Viola Heinzelmann, professor         
Swiss Medical Network - Clinique de Genolier Recruiting
Genolier, Switzerland
Contact: Matti Aapro, professor    +41 22 366 91 34    maapro@genolier.net   
Sponsors and Collaborators
Helsinn Healthcare SA
Investigators
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Study Chair: Alex Molasiotis, prof. University of Derby
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Responsible Party: Helsinn Healthcare SA
ClinicalTrials.gov Identifier: NCT04817189    
Other Study ID Numbers: IBA1160
First Posted: March 26, 2021    Key Record Dates
Last Update Posted: November 9, 2022
Last Verified: November 2022
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No
Additional relevant MeSH terms:
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Vomiting
Signs and Symptoms, Digestive
Dexamethasone
Ondansetron
Palonosetron
Granisetron
Tropisetron
Dolasetron
Anti-Inflammatory Agents
Antiemetics
Autonomic Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Gastrointestinal Agents
Glucocorticoids
Hormones
Hormones, Hormone Substitutes, and Hormone Antagonists
Antineoplastic Agents, Hormonal
Antineoplastic Agents
Antipruritics
Dermatologic Agents
Serotonin Antagonists
Serotonin Agents
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action
Antipsychotic Agents
Tranquilizing Agents
Central Nervous System Depressants
Psychotropic Drugs
Anti-Anxiety Agents