Evaluation of the Efficacy and Acceptability of a Phytotherapy Combining Devil's Claw, Blackcurrant and Meadowsweet for the Management of Aromatase Inhibitor-induced Arthralgia in Patients Treated for Localized Breast Cancer in the Adjuvant Setting (ERABLE)

Adjuvant hormonotherapy is a cornerstone of treatment for localized hormone receptor-positive (HR+) breast cancer, accounting for approximately 80% of patients. The main classes used are selective estrogen receptor modulators (SERMs, including tamoxifen) and aromatase inhibitors (anastrozole, letrozole, exemestane), with or without LH-RH agonists (leuprorelin, goserelin), administered daily for 5 to 8 years.

However, these treatments are frequently associated with adverse events, predominantly musculoskeletal disorders such as arthralgia, which can significantly impair quality of life. These symptoms cause functional impact and promote premature discontinuation of treatment, thereby compromising therapeutic adherence and increasing the risk of tumor relapse.

Current management strategies for these arthralgias, whether pharmacological or non-pharmacological, show limited efficacy or insufficient levels of evidence, with the exception of certain approaches like acupuncture. In the absence of satisfactory solutions, many patients turn to alternative medicines, notably phytotherapy. However, these practices raise safety concerns (drug interactions, misuse) and rely on limited scientific evidence, especially since they are often underreported to healthcare professionals.

In this context, there is a clear need to rigorously evaluate new therapeutic approaches. The non-randomized ERABLE study aims to explore the efficacy and acceptability of a phytotherapy selected for its analgesic properties on hormone therapy-induced arthralgia in patients treated for localized breast cancer. If positive, this study will be followed by a randomized trial to confirm efficacy and achieve a level of evidence compatible with clinical guidelines.

Study Overview

• Status: Not yet recruiting
• Conditions: Joint Pain; Adjuvant Treatment; Symptom Management; Hormone Therapy-induced Arthralgia; Phytotherapy; Patient Acceptability
• Intervention / Treatment: Dietary supplement: Phytotherapy Dietary Supplement (Harpagophytum, Meadowsweet, and Blackcurrant); Other: Patient Experience Questionnaire

• Study Type: Interventional
• Enrollment (Estimated): 105
• Phase: Phase 4

Contacts and Locations

• Study Contact: Name: Gilles FREYER, Pr; Phone Number: +33 04 78 86 43 18; Email: gilles.freyer@chu-lyon.fr
• Study Contact Backup: Name: Angelique STUANI; Phone Number: +33 04 78 86 23 76; Email: angelique.stuani@chu-lyon.fr

Study Locations

• France
  • Bron, France
    • Oncology Unit, Hospices Civils de Lyon Est
    • Contact: Marie BEGUINOT, PU, MD; Phone Number: +33 04 72 35 58 85; Email: marie.beguinot@chu-lyon.fr
    • Principal Investigator: Marie BEGUINOT, PU, MD
  • Lyon, France
    • Oncology Unit, Hospices Civils de Lyon Nord
    • Contact: Eva KALFALA, PU, MD; Phone Number: +33 04 26 73 26 12; Email: Eva.kalfala@chu-lyon.fr
    • Principal Investigator: Eva KALFALA, PU, MD
  • Pierre-Bénite, France
    • Oncology Unit, Hospices Civils de Lyon Sud
    • Contact: Gilles FREYER, PU-PH; Phone Number: +33 04 78 86 43 18; Email: gilles.freyer@chu-lyon.fr
    • Principal Investigator: Gilles FREYER, PU-PH

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Female

Description

Inclusion Criteria:

• Common Inclusion Criteria (applicable to both cohorts):

1. Age 18 years or older.

2. Histologically or clinically confirmed localized breast cancer treated for at least 3 months with adjuvant hormone therapy according to standard clinical practices: selective estrogen receptor modulators (SERMs, e.g., tamoxifen alone), aromatase inhibitors (AIs, e.g., anastrozole, letrozole, or exemestane alone), or in combination with an LH-RH agonist (goserelin or leuprorelin). Concomitant targeted therapy with ribociclib or abemaciclib is permitted.

3. Suffering from hormone therapy-induced arthralgia with a severity score of $\ge 4/10$ on a numerical rating scale (NRS).

4. For women of childbearing potential: use of a highly effective contraception method throughout the study duration (excluding hormonal options, prioritizing mechanical methods such as a copper intrauterine device, male/female condoms, surgical methods like bilateral tubal ligation, or true abstinence).

   • Specific Inclusion Criteria for the Interventional Cohort:

5. Provided signed and dated written informed consent.

6. Affiliated with or a beneficiary of a social security regime.

   • Specific Selection Criteria for the External Control Group:

7. Availability of necessary clinical data required for the primary outcome evaluation (joint pain assessment at baseline/Day 0 and Day 21 $\pm 3$ days).

Exclusion Criteria:

• Specific Exclusion Criteria for the Interventional Cohort:

1. Presence of medical conditions contraindicating the active ingredients of the dietary supplement: active gastroduodenal ulcer, biliary disorders (gallstones), uncontrolled heart failure, or edematous renal failure.

2. Known allergy or hypersensitivity to any of the components of the dietary supplement (blackcurrant, meadowsweet, excipients, etc.).

3. Hypersensitivity to salicylates.

4. Pregnant or breastfeeding women.

5. Persons deprived of liberty or under legal guardianship/protection.

6. Inability to complete the study diary during the follow-up period based on the investigator's judgment (e.g., non-French speaking/allophone, dementia).

7. Impossibility to comply with the medical follow-up of the study for geographical, social, or psychological reasons.

8. Concurrent participation in another clinical, drug, or cosmetic research study.

   • Specific Non-Selection Criteria for the External Control Group:

9. Patient objection or refusal regarding the reuse of their medical data for research purposes.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Herbal dietary supplement group (interventional group); Patients in the interventional arm receive a daily oral herbal dietary supplement combining Devil's claw (Harpagophytum procumbens), Meadowsweet (Filipendula ulmaria), and Blackcurrant (Ribes nigrum). The intervention is administered in a capsule dosage form at a dose of 2 capsules twice daily (totaling 4 capsules per day) for a duration of 21 consecutive days. This supportive care treatment is taken concomitantly with the patient's ongoing, standard adjuvant hormone therapy (tamoxifen, aromatase inhibitors, or LH-RH analogues) to evaluate its efficacy in managing hormone therapy-induced arthralgia.	Dietary supplement: Phytotherapy Dietary Supplement (Harpagophytum, Meadowsweet, and Blackcurrant); Administration of an oral herbal dietary supplement combining Devil's claw (Harpagophytum procumbens), Meadowsweet (Filipendula ulmaria), and Blackcurrant (Ribes nigrum). The product is provided in capsule dosage form at a dose of 2 capsules twice daily (4 capsules per day) for a duration of 21 consecutive days, taken concomitantly with the patient's ongoing adjuvant hormone therapy to manage joint pain.; Other: Patient Experience Questionnaire; Administration of an ad hoc questionnaire utilizing Likert scales, conducted via telephone interview at Day 21. This tool evaluates the patient's feedback on three key implementation dimensions based on Proctor's framework: acceptability (overall perception, perceived satisfaction, and encountered difficulties), appropriateness (perceived relevance and suitability of the intervention), and feasibility.
No Intervention: Standard of care (External control); Patients in the external control group receive standard of care management for their hormone therapy-induced arthralgia, with no experimental phytotherapeutic intervention administered. Data regarding their joint pain are collected from routine clinical practice medical records, including a baseline numerical pain rating scale assessment (Day 0) and a follow-up assessment conducted by telephone at Day 21 (+ 3 days) during routine oncology follow-up. This group is matched with the interventional cohort based on clinical criteria such as age, hormone therapy type, and treatment line.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in joint pain score from baseline to day 21	Joint pain intensity is self-reported by the patient using an 11-point Numerical Rating Scale (NRS), where 0 represents "no pain" and 10 represents "worst imaginable pain." The primary outcome is calculated as the change in the NRS score from baseline (Day 0) to Day 21, comparing the interventional group with the matched external control group.	Baseline (Day 0) and Day 21 (+ 3 days)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in analgesic medication consumption	Patient self-reported consumption of analgesic treatments (paracetamol, non-steroidal anti-inflammatory drugs, tramadol, codeine-containing paracetamol, morphine sulfate, or oxycodone) recorded prospectively via a daily tracking diary during the first week (Day 0 to Day 7) and the final week (Day 14 to Day 21) of the study period.	Daily tracking during the first week (Day 0 to Day 7) and final week (Day 14 to Day 21) of the 21-day intervention period
Incidence and severity of adverse events (Tolerance)	Assessment of adverse events and treatment safety evaluated through patient reporting in the study diary and clinical monitoring throughout the intervention period. Toxicity is graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE v6.0).	Throughout the intervention and follow-up period, from Day 0 up to Day 28 (+ 3 days)
Patient experience assessment: acceptability, appropriateness, and feasibility	Evaluation of the patient's feedback regarding the phytotherapy dietary supplement using an ad hoc questionnaire with Likert scales based on Proctor's implementation framework. The questionnaire assesses three core dimensions: acceptability (overall perception, satisfaction, and difficulties encountered), appropriateness (perceived relevance and suitability of the intervention), and feasibility.	Day 21 (+ 3 days) via telephone interview

Collaborators and Investigators

• Sponsor: Hospices Civils de Lyon
• Collaborators: IPHYM
• Investigators: Principal Investigator: Gilles FREYER, Pr, Hospices Civils de Lyon

Study record dates

Study Major Dates

• Study Start (Estimated): January 1, 2027
• Primary Completion (Estimated): March 1, 2028
• Study Completion (Estimated): March 1, 2028

Study Registration Dates

• First Submitted: September 29, 2026
• First Submitted That Met QC Criteria: September 29, 2026
• First Posted (Actual): October 5, 2026

Study Record Updates

• Last Update Posted (Actual): November 3, 2026
• Last Update Submitted That Met QC Criteria: November 2, 2026
• Last Verified: November 1, 2026

More Information

Terms related to this study

• Keywords: Quality of life; Breast cancer; Adjuvant treatment; Phytotherapy; Hormone therapy-induced arthralgia
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Musculoskeletal Diseases; Neoplasms by Site; Neoplasms; Joint Diseases; Skin Diseases; Breast Diseases; Pathological Conditions, Signs and Symptoms; Skin and Connective Tissue Diseases; Signs and Symptoms; Breast Neoplasms; Arthralgia
• Other Study ID Numbers: 69HCL26_0268; 2026-A02232-49 (Other Identifier: ID-RCB)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No