Effects of traditional Chinese medicine collaborative model (TCMCM) combined with adjuvant chemotherapy on IIIb and IIIc gastric cancer: a protocol for a randomized controlled trial

Zhaoyan Li, Guangtao Zhang, Nida Cao, Jingjuan Xu, Jiahuan Dong, Jia Li, Xiaohong Zhu, Yan Xu, Chen Han, Rui Wang, Xiang Xia, Gang Zhao, Xiangkun Huan, Jin Fan, Aiguang Zhao, Zhaoyan Li, Guangtao Zhang, Nida Cao, Jingjuan Xu, Jiahuan Dong, Jia Li, Xiaohong Zhu, Yan Xu, Chen Han, Rui Wang, Xiang Xia, Gang Zhao, Xiangkun Huan, Jin Fan, Aiguang Zhao

Abstract

Background: Metastasis and/or recurrence can decrease the survival time of gastric cancer patients undergoing radical operation. Among them, those with stage IIIb and IIIc are especially at a high risk of metastasis and recurrence. The traditional Chinese medicine collaborative model (TCMCM) has been used in the treatment of cancer; however, its effects have not been systematically evaluated. This study is designed to evaluate whether TCMCM can decrease adverse effects after chemotherapy and reduce the recurrence and metastasis of stage IIIb and IIIc gastric cancer.

Methods/design: This prospective, multicenter, randomized, open-label trial will recruit 260 patients with stage IIIb and IIIc gastric cancer who undergo radical surgery for D2 lymphadenectomy. The patients will be randomly assigned to receive usual adjuvant chemotherapy and TCMCM (intervention group) in a 1:1 ratio. Patients in the intervention group will receive an oral traditional Chinese formula, auricular acupressure, and acupoint therapy. All participants will receive usual adjuvant chemotherapy. The primary outcome is a 3-year disease-free survival rate. Secondary outcomes include quality of life, side effects caused by chemotherapy, and safety-related measures. Assessments will be performed during the screening period, at 4 and 8 cycles after adjuvant chemotherapy, and 9, 12, 18, 24, 30, and 36 months after randomization. Adverse events will be recorded. In addition, biological samples will be collected for mechanism analysis.

Discussion: This will be the first clinical trial to evaluate the effects of TCMCM on disease-free survival (DFS) and quality of life in patients with stage IIIb and IIIc gastric cancer. Our results may be used to standardize TCMCM. We will also perform a larger-scale clinical trial in the future.

Trial registration: ClinicalTrials.gov NCT03607656 . Registered on 1 July 2018. The final protocol version is V1.1.

Keywords: Adjuvant chemotherapy; DFS; Gastric cancer; Randomized controlled trial; Traditional Chinese medicine collaborative model.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
The trial design

References

    1. Chen W, Zheng R, Baade PD, Zhang S, Zeng H, Bray F, Jemal A, Yu XQ, He J. Cancer statistics in China, 2015. Ca Cancer J Clin. 2016;66(2):115–132. doi: 10.3322/caac.21338.
    1. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359–E386. doi: 10.1002/ijc.29210.
    1. Wei W, Zhe S, Jing-Yu D, Xiao-Long Q, Xing-Yu F, Cheng F, et al. A novel nomogram individually predicting disease-specific survival after D2 gastrectomy for advanced gastric cancer. Cancer Commun. 2018;38(1):23. doi: 10.1186/s40880-018-0293-0.
    1. Higgins RS, Brown RN, Chang PP, Starling RC, Ewald GA, Tallaj JA, Kirklin JK, George JF. A multi-institutional study of malignancies after heart transplantation and a comparison with the general United States population. J Heart Lung Transplant. 2014;33(5):478–485. doi: 10.1016/j.healun.2014.01.862.
    1. Foo M, Leong T. Adjuvant therapy for gastric cancer: current and future directions. World J Gastroentero. 2014;20(38):13718–13727. doi: 10.3748/wjg.v20.i38.13718.
    1. Al-Batran SE, Hofheinz RD, Pauligk C, Kopp HG, Haag GM, Luley KB, et al. Histopathological regression after neoadjuvant docetaxel, oxaliplatin, fluorouracil, and leucovorin versus epirubicin, cisplatin, and fluorouracil or capecitabine in patients with resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4-AIO): results from the phase 2 part of a multicentre, open-label, randomised phase 2/3 trial [J] Lancet Oncol. 2016;17(12):1697–1708. doi: 10.1016/S1470-2045(16)30531-9.
    1. Sasako M, Sakuramoto S, Katai H, Kinoshita T, Furukawa H, Yamaguchi T, Nashimoto A, Fujii M, Nakajima T, Ohashi Y. Five-year outcomes of a randomized phase III trial comparing adjuvant chemotherapy with S-1 versus surgery alone in stage II or III gastric cancer. J. Clin.Oncol. 2011;29(33):4387–4393. doi: 10.1200/JCO.2011.36.5908.
    1. Noh SH, Park SR, Yang HK, Chung HC, Chung IJ, Kim SW, Kim HH, Choi JH, Kim HK, Yu W, Lee JI, Shin DB, Ji J, Chen JS, Lim Y, Ha S, Bang YJ, CLASSIC trial investigators Adjuvant capecitabine plus oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): 5-year follow-up of an open-label, randomised phase 3 trial. Lancet Oncol. 2014;15(12):1389–1396. doi: 10.1016/S1470-2045(14)70473-5.
    1. Al-Batran SE, Homann N, Pauligk C, Goetze TO, Meiler J, Kasper S, et al. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. Lancet. 2019;393(10184):1948–1957. doi: 10.1016/S0140-6736(18)32557-1.
    1. Smalley SR, Benedetti JK, Haller DG, Hundahl SA, Estes NC, Ajani JA, Gunderson LL, Goldman B, Martenson JA, Jessup JM, Stemmermann GN, Blanke CD, Macdonald JS. Updated analysis of SWOG-Directed intergroup study 0116: a phase III trial of adjuvant radiochemotherapy versus observation after curative gastric cancer resection. J. Clin.Oncol. 2012;30(19):2327–2333. doi: 10.1200/JCO.2011.36.7136.
    1. Hejna M, Wöhrer S, Schmidinger M, Raderer M. Postoperative chemotherapy for gastric cancer. Oncologist. 2006;11(2):136–145. doi: 10.1634/theoncologist.11-2-136.
    1. Schwartzberg LS, Modiano MR, Rapoport BL, Chasen MR, Gridelli C, Urban L, Poma A, Arora S, Navari RM, Schnadig ID. Safety and efficacy of rolapitant for prevention of chemotherapy-induced nausea and vomiting after administration of moderately emetogenic chemotherapy or anthracycline and cyclophosphamide regimens in patients with cancer: two randomised, active-controlled, double-blind, phase 3 trials. Lancet Oncol. 2015;16(9):1079–1089. doi: 10.1016/S1470-2045(15)00034-0.
    1. Efferth T, Li PCH, Konkimalla VSB, Kaina B. From traditional Chinese medicine to rational cancer therapy. Trends Mol Med. 2007;13(8):353–361. doi: 10.1016/j.molmed.2007.07.001.
    1. Yu KL, Bae K, Yoo HS, Cho SH. Benefit of adjuvant traditional herbal medicine with chemotherapy for resectable gastric cancer [J] Integr Cancer Ther. 2018;17(3):619–627. doi: 10.1177/1534735417753542.
    1. Lyman GH, Greenlee H, Bohlke K, Bao T, DeMichele AM, Deng GE. Integrative therapies during and after breast cancer treatment: ASCO endorsement of the SIO clinical practice guideline. J Clin Oncol. 2018, 36(25):2647-55.16. Eghbali M, Yekaninejad MS, Varaei S, Jalalinia SF, Samimi MA, Sa'Atchi K. The effect of auricular acupressure on nausea and vomiting caused by chemotherapy among breast cancer patients. Complement Ther Clin Pract. 2016;24:189–194. doi: 10.1016/j.ctcp.2016.06.006.
    1. Zhou X, Yan DM, Zhu WF, Liu WJ, Nie HY, Xu S, Jiang YP, Zhang KH, Fu Y, Wan YY, Yu XY, Li H, Sun X, Chen XF. Efficacy and safety of Hou Gu Mi Xi in patients with spleen qi deficiency syndrome who underwent radical gastrectomy for gastric cancer: protocol for a multicenter, randomized, double-blind, placebo-controlled trial. Trials. 2019;20(1):343. doi: 10.1186/s13063-019-3429-x.
    1. Okabe H, Kinjo Y, Obama K, Hosogi H, Hata H, Asao Y, Harada H, Manaka D, Itami A, Teramukai S, Sakai Y. A randomized phase II study of S-1 randomized phase with or without hochu-ekki-to, a Japanese herbal medicine, for stage II/III gastric cancer: the KUGC07 (SHOT) trial. Front Oncol. 2019;9:294–300. doi: 10.3389/fonc.2019.00294.
    1. Hung KF, Hsu CP, Chiang JH, Lin HJ, Kuo YT, Sun MF, Yen HR. Complementary Chinese herbal medicine therapy improves survival of patients with gastric cancer in Taiwan: a nationwide retrospective matched-cohort study. J Ethnopharmacol. 2017;199:168–174. doi: 10.1016/j.jep.2017.02.004.
    1. Lee YK, Bae K, Yoo HS, Cho SH. Benefit of adjuvant traditional herbal medicine with chemotherapy for resectable gastric cancer. Integr Cancer Ther. 2018;17(3):619–627. doi: 10.1177/1534735417753542.
    1. Xu Y, Zhao AG, Li ZY, Zhao G, Cai Y, Zhu XH, Cao ND, Yang JK, Zheng J, Gu Y, Han YY, Zhu YJ, Yang JZ, Gao F, Wang Q. Survival benefit of traditional Chinese herbal medicine (a herbal formula for invigorating spleen) for patients with advanced gastric cancer. Integr Cancer Ther. 2013;12(5):414–422. doi: 10.1177/1534735412450512.
    1. Zhao L, Zhao AG, Zhao G, Xu Y, Zhu XH, Cao ND, Zheng J, Yang JK, Xu JH. Survival benefit of traditional Chinese herbal medicine (a herbal formula for invigorating spleen) in gastric cancer patients with peritoneal metastasis. Evid-based Compl Alt. 2014;2014:625493–625496. doi: 10.1155/2014/625493.

Source: PubMed

3
Subskrybuj