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Mersiades AJ, Tognela A, Haber PS, Stockler M, Lintzeris N, Simes J, McGregor I, Olver I, Allsop DJ, Gedye C, Kirby AC, Morton RL, Fox P, Clarke S, Briscoe K, Aghmesheh M, Wong N, Walsh A, Hahn C, Grimison P. Oral cannabinoid-rich THC/CBD cannabis extract for secondary prevention of chemotherapy-induced nausea and vomiting: a study protocol for a pilot and definitive randomised double-blind placebo-controlled trial (CannabisCINV). BMJ Open 2018; 8:e020745. [PMID: 30209152 PMCID: PMC6144412 DOI: 10.1136/bmjopen-2017-020745] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 06/07/2018] [Accepted: 06/21/2018] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Chemotherapy-induced nausea and vomiting (CINV) remains an important issue for patients receiving chemotherapy despite guideline-consistent antiemetic therapy. Trials using delta-9-tetrahydrocannabinol-rich (THC) products demonstrate limited antiemetic effect, significant adverse events and flawed study design. Trials using cannabidiol-rich (CBD) products demonstrate improved efficacy and psychological adverse event profile. No definitive trials have been conducted to support the use of cannabinoids for this indication, nor has the potential economic impact of incorporating such regimens into the Australian healthcare system been established. CannabisCINV aims to assess the efficacy, safety and cost-effectiveness of adding TN-TC11M, an oral THC/CBD extract to guideline-consistent antiemetics in the secondary prevention of CINV. METHODS AND ANALYSIS The current multicentre, 1:1 randomised cross-over, placebo-controlled pilot study will recruit 80 adult patients with any malignancy, experiencing CINV during moderate to highly emetogenic chemotherapy despite guideline-consistent antiemetics. Patients receive oral TN-TC11M (THC 2.5mg/CBD 2.5 mg) capsules or placebo capsules three times a day on day -1 to day 5 of cycle A of chemotherapy, followed by the alternative drug regimen during cycle B of chemotherapy and the preferred drug regimen during cycle C. The primary endpoint is the proportion of subjects attaining a complete response to CINV. Secondary and tertiary endpoints include regimen tolerability, impact on quality of life and health system resource use. The primary assessment tool is patient diaries, which are filled from day -1 to day 5. A subsequent randomised placebo-controlled parallel phase III trial will recruit a further 250 patients. ETHICS AND DISSEMINATION The protocol was approved by ethics review committees for all participating sites. Results will be disseminated in peer-reviewed journals and at scientific conferences. DRUG SUPPLY Tilray. PROTOCOL VERSION 2.0, 9 June 2017. TRIAL REGISTRATION NUMBER ANZCTR12616001036404; Pre-results.
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Affiliation(s)
- Antony J Mersiades
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Annette Tognela
- Macarthur Cancer Therapy Centre, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - Paul S Haber
- Discipline of Addiction Medicine, University of Sydney, Sydney, New South Wales, Australia
- Drug Health Services, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Martin Stockler
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
- Department of Medical Oncology, Concord Cancer Care Centre, Concord Hospital, Sydney, New South Wales, Australia
| | - Nicholas Lintzeris
- Discipline of Addiction Medicine, University of Sydney, Sydney, New South Wales, Australia
- Drug and Alcohol Services, South East Sydney Local Health District, Sydney, New South Wales, Australia
| | - John Simes
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
- Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Iain McGregor
- Lambert Initiative for Cannabinoid Therapeutics, University of Sydney, Sydney, New South Wales, Australia
| | - Ian Olver
- University of South Australia Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
| | - David J Allsop
- Lambert Initiative for Cannabinoid Therapeutics, University of Sydney, Sydney, New South Wales, Australia
| | - Craig Gedye
- Department of Medical Oncology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
| | - Adrienne C Kirby
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Peter Fox
- Central West Cancer Care Centre, Orange Health Service, Orange, New South Wales, Australia
| | - Stephen Clarke
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Bill Walsh Cancer Research Laboratory, Kolling Institute of Medical Research, Sydney, New South Wales, Australia
| | - Karen Briscoe
- Mid North Coast Cancer Institute, Coffs Harbour Hospital, Coffs Harbour, New South Wales, Australia
| | - Morteza Aghmesheh
- Illawarra Shoalhaven Cancer and Haematology Network, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Nicole Wong
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Anna Walsh
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Carmel Hahn
- Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Peter Grimison
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
- Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
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