Bupropion to Reduce Cancer Related Fatigue in Cancer Survivors

PRIMARY OBJECTIVE:

I. To determine the efficacy of bupropion hydrochloride controlled-release (bupropion) versus placebo in reducing fatigue in a double-blinded, placebo-controlled, randomized clinical trial of cancer survivors with fatigue.

SECONDARY OBJECTIVES:

I. To assess the efficacy of bupropion versus placebo on depression and quality of life in cancer survivors with fatigue.

II. To assess the tolerability of bupropion in cancer survivors with fatigue.

EXPLORATORY OBJECTIVES:

I. To assess the efficacy of bupropion versus placebo on symptomatology and cognition in cancer survivors with fatigue.

II. To explore the effects of bupropion on putative mechanisms of cancer-related fatigue.

III. To explore associations of CYP2B6 genotype with bupropion metabolism and changes in fatigue.

OUTLINE: Patients are randomized to 1 of 2 arms.

ARM I: Patients receive bupropion hydrochloride controlled-release orally (PO) once daily (QD) for up to 13 weeks in the absence of unacceptable toxicity. Patients also undergo blood sample collection throughout study.

ARM II: Patients receive placebo PO QD for up to 13 weeks in the absence of unacceptable toxicity. Patients also undergo blood sample collection throughout study.

• Biospecimen Collection (Procedure), also known as Biological Sample Collection, Biospecimen Collected, Specimen Collection: Undergo blood sample collection
• Bupropion Hydrochloride Controlled-release (Drug), also known as Bupropion HCl Controlled-release, Bupropion HCl Extended Release, Bupropion Hydrochloride Extended-Release, Forfivo XL, Wellbutrin SR, Wellbutrin XL, Zyban: Given PO
• Placebo Administration (Other): Given PO
• Quality-of-Life Assessment (Other), also known as Quality of Life Assessment: Ancillary studies
• Questionnaire Administration (Other): Ancillary studies

Primary outcomes

• Fatigue [At baseline and 12 weeks]: Measured by the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) Fatigue subscale (FFS). Scale scores range from 0-4; lower scores indicate greater fatigue. Will use analysis of covariance with group as the main factor and baseline FFS as a covariate.

Secondary outcomes

• Quality of life [At baseline and 12 weeks]: Measured by the Total Score of the Functional Assessment Cancer Therapy - General (FACT-G) scale (included in the FACIT-F). The FACT-G consists of four subscales: physical well-being, functional well-being), emotional well-being, and social well-being. Scores on the four subscales are summed to produce a total score ranging from 0 to 108 with higher scores indicating better quality of life. This will be utilized to estimate the indirect (mediation) and direct effects and to obtain bootstrap-based 95% confidence intervals for these effects.
• Depression [At baseline and 12 weeks]: Measured by the Patient Reported Outcomes Measurement Information System (PROMIS) Depression Short Form 8a. Will perform mediation analyses.

Other outcomes

• Cognition [At baseline and 12 weeks]: Measured by the PROMIS Cognitive Functioning 8a and Cognitive Abilities 4a measures. Will perform mediation analyses.
• Symptomatology [At baseline and 12 weeks]: Measured by the M.D. Anderson Symptom Inventory.

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* Be at least 18 years of age
* Be diagnosed with cancer
* Have stable disease or no evidence of disease
* Report WORST level of fatigue in the past week as moderate to severe (i.e., a score >= 4 on a 0-10 scale, screening measures, question 1)
* Have completed surgery, radiation, and/or systemic intravenous anticancer therapy (e.g., chemotherapy, targeted therapy, immunotherapy) 2 or more months prior to enrollment. Participants currently receiving oral maintenance, targeted, or hormonal therapy are eligible. Participants receiving intravenous supportive therapy (e.g., bisphosphonates) are eligible
* Able to read and speak English
* Currently not pregnant or breastfeeding. Women of child-bearing potential must agree to use adequate contraception, i.e, abstinence, IUD (intrauterine device), hormonal contraceptive (birth control pills) or barrier method (condoms) prior to study entry and for the duration of study participation
* Be capable of providing written informed consent

Exclusion Criteria:

* Be receiving intravenous anti-cancer therapy (e.g., intravenous immune checkpoint inhibitor therapy, targeted therapy)
* Be currently taking any medications that contain bupropion (e.g., Wellbutrin, Forfivo, Aplenzin, or Zyban)
* Be taking an monoamine oxidase inhibitor (MAOI), linezolid, or methylene blue within two weeks prior to enrollment
* Be taking any anti-psychotic medications within a week prior to enrollment
* Have a history of renal impairment (i.e., glomerular filtration rate < 45)
* Have a history of cirrhosis (i.e., Child-Pugh score >= 5)
* Have a history of seizures
* Have a history of bulimia or anorexia nervosa
* Report a history of sensitivity to bupropion
* Report an allergy to lactose
* Have psychiatric or neurological disorder(s) that would interfere with study participation per physician or physician's designee

442 more sites not listed.

• Heather S Jim, Principal investigator, University of Rochester NCORP Research Base

NIH grants: R01CA214647, UG1CA189961