Auricular Point Stimulation Plus Dexamethasone Versus Standard Antiemetic Regimen for Nausea and Vomiting Caused by Gemcitabine Combined With Paclitaxel Protein-bound (ADGP Ⅱ)

Gemcitabine combined with paclitaxel protein-bound is currently one of the commonly used chemotherapy regimens for postoperative adjuvant and palliative treatment of pancreatic cancer. While it improves patient survival rates, it is also associated with certain gastrointestinal adverse reactions. Chemotherapy-related nausea and vomiting are relatively common, with an incidence of approximately 10%. The majority of these symptoms occur on the day of administration and within the following four days. This regimen is currently classified as a low-emetogenic-risk treatment in clinical guidelines. The recommended prophylactic antiemetic strategy typically involves corticosteroids (e.g., dexamethasone) and/or 5-HT3 receptor antagonists (e.g., ondansetron, palonosetron). In clinical practice, single-agent antiemetic therapy often fails to effectively prevent delayed nausea and vomiting. Consequently, most physicians opt for dual-agent antiemetic therapy. However, excessive use of antiemetics frequently leads to drug-related gastrointestinal adverse reactions such as anorexia, bloating, constipation, and diarrhea. Studies have shown that the incidence of constipation in chemotherapy patients treated with palonosetron nearly doubles. The intensive use of antiemetics severely impacts patients' gastrointestinal function, quality of life, and even their treatment adherence. Therefore, how to effectively prevent chemotherapy-induced nausea and vomiting while minimizing the side effects of antiemetic therapy itself has become a practical issue that healthcare professionals urgently need to address. Auricular point pressotherapy is a traditional Chinese medicine (TCM) external therapy. It involves accurately pasting Vaccaria seeds on corresponding auricular points with adhesive tapes and stimulating the points through moderate pressing to regulate physical functions and treat diseases. According to TCM theory, the ear is closely connected to the internal organs and meridians of the human body, and all twelve meridians are directly or indirectly linked to the ear. Auricular point pressotherapy can unblock meridians and balance yin and yang by stimulating corresponding auricular points, thereby alleviating CINV and other adverse reactions. It is an economical, non-invasive, and low-side-effect natural therapy. Meanwhile, auricular point pressotherapy can effectively improve gastrointestinal function, thus significantly reducing gastrointestinal dysfunction caused by chemotherapy and antiemetic drugs, such as anorexia, abdominal distension, constipation, and diarrhea. Our team summarized the relevant data of patients who voluntarily received auricular point pressotherapy for antiemesis previously. The results showed that among pancreatic cancer patients who received gemcitabine combined with paclitaxel protein-bound for postoperative adjuvant or palliative therapy, 100% of those treated with auricular point pressotherapy plus dexamethasone did not experience grade 2 or above (including grade 2) nausea and had no vomiting on the day of medication and within 3 days thereafter. Based on the above theoretical and practical basis, this study intends to evaluate whether the preventive and suppressive effects of auricular point stimulation combined with dexamethasone on the CINV induced by the gemcitabine plus paclitaxel protein-bound regimen are non-inferior to the standard antiemetic regimen. Additionally, it will assess patients' appetite, gastrointestinal function, and other related indicators, and explore the significant role of integrated traditional Chinese medicine and Western medicine interventions in improving patients' quality of life during chemotherapy, thereby providing a clinical reference for optimizing the management of adverse reactions of this chemotherapy regimen.