A Study on Nausea and Vomiting Caused by T-DXd in Breast Cancer Patients

NCT07254416 — Phase 4, Not yet recruiting, 120 participants, Tianjin Medical University Cancer Institute and Hospital

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To Evaluate the Efficacy and Safety of NEPA Combined With Megestrol Acetate Versus NEPA Combined With Dexamethasone in Preventing Nausea and Vomiting Caused by T-DXd in Breast Cancer Patients

Registry	NCT07254416
Status	Not yet recruiting
Phase	Phase 4
Study type	Interventional; randomized, parallel, masking: none, prevention
Enrollment	120 (Estimated)
Sponsor	Tianjin Medical University Cancer Institute and Hospital (Other); collaborators: Shaanxi Provincial Cancer Hospital, The First Affiliated Hospital of Henan University of Science and Technology, Shanxi Bethune Hospital, Tianjin Cancer Hospital Airport Hospital
Conditions	Breast Cancer Patients Treated With T-DXd
Interventions	NEPA, Dexamethasone, Megestrol Acetate (Drug)
Dates	start 2025-12-15 (estimated), primary completion 2026-12-31 (estimated), completion 2027-06-30 (estimated), first posted 2025-11-28, last updated 2025-11-28

-Summary

This study was a multicenter, prospective, controlled trial involving 120 breast cancer patients receiving T-DXd-based therapy. Participants were randomly assigned to either the experimental group (NEPA plus megestrol acetate) or the control group (NEPA plus dexamethasone), with 60 patients in each group. The intervention was administered over two treatment cycles. During this period, the onset time, frequency, and severity of nausea and vomiting were recorded and subjected to statistical analysis.

The primary objective of this study was to evaluate the efficacy and safety of netupitant/palonosetron capsules (NEPA) combined with megestrol acetate compared to the standard triple antiemetic regimen (NEPA plus dexamethasone) in preventing chemotherapy-induced nausea and vomiting (CINV) in breast cancer patients undergoing T-DXd-containing regimens. The findings aim to generate clinical evidence to support optimal antiemetic management, minimize the risk of dose reduction or treatment discontinuation due to gastrointestinal adverse events, and ultimately improve patient quality of life.

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+Arms and interventions

Arm	Type	Interventions	Description
NEPA+ Megestrol Acetate	Experimental	Drug: NEPA; Drug: Megestrol Acetate
NEPA+ Dexamethasone	Active comparator	Drug: NEPA; Drug: Dexamethasone

NEPA (Drug): On the first day, oral administration of NEPA(netopitan 300mg+ palonosetron 0.50mg)
Dexamethasone (Drug): On the first day, oral administration of dexamethasone 6mg; From the 2nd to the 4th day, take dexamethasone 3.75mg orally per day.
Megestrol Acetate (Drug): From the 1st to the 10th day, take 160mg of Megestrol Acetate orally per day.

+Outcome measures

Primary outcomes

The CR rate within 0-120 hours (0-5 days) after the first cycle of T-Dxd treatment [0-120 hours (0-5 days)]

Secondary outcomes

The CR rates of 0-24 hours, 24-120 hours, 120-240 hours and 0-504 hours after the first and second cycles of T-Dxd treatment. [0-24 hours, 24-120 hours, 120-240 hours and 0-504 hours]
The CR rate within 0-120 hours (0-5 days) after the first cycle of T-Dxd treatment [0-120 hours (0-5 days)]
The CC rates of 0-24 hours, 24-120 hours, 0-120 hours, 120-240 hours and 0-504 hours after the first and second cycles of T-Dxd treatment. [0-24 hours, 24-120 hours, 0-120 hours, 120-240 hours and 0-504 hours]
The time and duration of the first significant nausea and vomiting. [From the administration of T-Dxd to 21 days]
The proportion of patients undergoing salvage treatment. [From the administration of T-Dxd to 21 days]
The incidence of ADC reduction due to adverse reactions [From the administration of T-Dxd to 21 days]
Evaluation of the EORTC QLQ-C30 (version 3) Quality of Life Questionnaire. [From the administration of T-Dxd to 21 days]

+Eligibility

Sex: All, ages: 18 Years to any

Inclusion Criteria:

1. The patient is at least 18 years of age;
2. The patient has a histologically or cytologically confirmed diagnosis of breast cancer;
3. The patient is receiving full-dose trastuzumab deruxtecan (T-DXd) monoclonal antibody therapy for the first time;
4. The patient has an Eastern Cooperative Oncology Group (ECOG) performance status score of 2 or lower;
5. The patient voluntarily agrees to comply fully with the study protocol requirements and has provided written informed consent.

Exclusion Criteria:

1. The patient is currently taking medications that may interfere with the assessment of nausea or vomiting, including but not limited to other 5-HT3 receptor antagonists, NK1 receptor antagonists, psychotropic agents, or opioid analgesics;
2. The investigator determines that the patient's nausea or vomiting is highly likely attributable to anti-tumor treatments not involving antibody-drug conjugate (ADC) therapy;
3. The patient is deemed unsuitable for glucocorticoid or progesterone use;
4. The patient has a history of hypersensitivity to netupitant, palonosetron, or any excipient in the capsule formulation;
5. The patient has significant gastrointestinal conditions affecting oral drug absorption, such as dysphagia, chronic diarrhea, or intestinal obstruction;
6. The patient has a severe psychiatric disorder or difficulties understanding the study procedures, completing questionnaires, or communicating effectively in Chinese;
7. The investigator identifies any other condition that may compromise the conduct of the clinical study or the interpretation of its results.