Capsaicin to Prevent Delayed Chemotherapy Induced Nausea and Vomiting (CapCIN)

Phase 2

Completed

• Conditions: Chemotherapy-induced Nausea and Vomiting
• Interventions: Drug: Capsaicin; Drug: Placebo

• Registration Number: NCT04918069
• Lead Sponsor: Christian Medical College, Vellore, India

Brief Summary

Chemotherapy-induced nausea and vomiting (CINV) is one of the few most severe adverse effects of chemotherapy, which often panic patients undergoing cancer treatment. Though acute episodes of CINV are well controlled with pharmacologic agents, delayed CINV continues to present a treatment challenge.

Significant progress has been made over the past many years in discovering the pathophysiology of CINV. Primarily, three areas in the brain including central pattern generator (CPG), nucleus tractus solitarius (NTS) and area postrema (AP) are implicated in generating emetic reflex in all types of CINV (anticipatory, acute and delayed). The latter two areas NTS and AP are located at the caudal end of the fourth ventricle of brain which lies outside of the blood brain barrier and hence are stimulated by agents present in either blood and/or cerebrospinal fluid (CSF). Furthermore, NTS and AP are rich in muscarinic, dopamine, serotonin, neurokinin (NK1) and histamine receptors which are particularly important in delayed CINV. Clinical trials of antimuscarinic, antidopaminergic, antihistaminic drugs to prevent CINV have yielded inconclusive results except for olanzapine which is known to act on multiple receptors in NTS/AP. Only NK1 antagonists (e.g. aprepitant) which prevent substance P (SP) from binding to NK1 receptors have shown promising results and are clinically used to prevent delayed CINV. SP is a tachykinin peptide encoded by TAC1 (tachykinin precursor 1) gene and is found abundant in both peripheral and CNS. NK1 receptors in NTS/AP upon binding with SP will generate emetic reflex which will trigger delayed CINV. Though the topical analgesic drug capsaicin is reported to interfere with endogenous SP, its antiemetic potential in CINV has not been studied. This study intend to explore the antiemetic potential of capsaicin which is known to interfere with SP release in the GIT and CNS.

Detailed Description

Not available

Study Timeline

• Study Start: 2019-10-18
• Study First Submitted: 2021-06-02
• Study First Submitted QC: 2021-06-02
• Study First Posted: 2021-06-08
• Status Verified: 2022-05
• Primary Completion: 2022-05-14
• Study Completion: 2022-05-14
• Last Update Submitted: 2022-05-14
• Last Update Posted: 2022-05-20

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 160

Inclusion Criteria

1. Adult chemotherapy naïve patients of at least 18 years old
2. Diagnosed with a malignant disease and scheduled for highly emetogenic chemotherapy (as defined by NCCN guidelines v1.2019)
3. No concurrent radiotherapy or use of other antiemetic drugs except (dexamethasone, ondansetron/granisetron, and olanzapine)
4. Normal renal and hepatic function

Exclusion Criteria

1. Pregnant or breast feeding
2. Contraindication for capsaicin or other medications in the study
3. Has ongoing nausea and/or vomiting of other etiology
4. History of anticipatory nausea and/or vomiting or has vomited/nauseated within 24 hours prior to the start of scheduled chemotherapy
5. Chronic alcoholism

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Capsaicin	Capsaicin	2g of 0.075% topical capsaicin ointment applied four times daily (preferably to the abdomen) for the first five days of chemotherapy
Placebo	Placebo	2g of topical placebo ointment applied four times daily (preferably to the abdomen) for the first five days of chemotherapy

Primary Outcome Measures

Name	Time	Method
Nausea	Within 15 days of chemotherapy	Number of participants with chemotherapy-induced nausea that occurs after 24 hours of the first cycle
Vomiting	Within 15 days of chemotherapy	Number of participants with chemotherapy-induced vomiting that occurs after 24 hours of the first cycle

Secondary Outcome Measures

Name	Time	Method
Overall chemotherapy-induced nausea and vomiting	Within 15 days of chemotherapy	Number of participants with both immediate and delayed chemotherapy-induced nausea and vomiting
Severity of chemotherapy-induced nausea and vomiting	Within 15 days of chemotherapy	Number of participants with severe, moderate and mild chemotherapy-induced nausea and vomiting
Use of rescue medication	Within 15 days of chemotherapy	Number of participants requiring rescue medication for nausea and vomiting

Trial Locations

Locations (1)

Christian Medical College; 🇮🇳 Vellore, Tamilnadu, India