Skip to main content
Top
Published in: Trials 1/2016

Open Access 01-12-2016 | Study protocol

A multicenter randomized controlled open-label trial to assess the efficacy of compound kushen injection in combination with single-agent chemotherapy in treatment of elderly patients with advanced non-small cell lung cancer: study protocol for a randomized controlled trial

Authors: Xue-qian Wang, Jie Liu, Hong-sheng Lin, Wei Hou

Published in: Trials | Issue 1/2016

Login to get access

Abstract

Background

With the aging of the global population, an increasing number of elderly are diagnosed with advanced non-small cell lung cancer. Although systematic chemotherapy has been one of the primary treatments for advanced non-small cell lung cancer worldwide, the elderly cannot always tolerate standard platinum-based doublet chemotherapy, thus resulting in treatment failure. To reduce toxicity, single-agent chemotherapy is often used to treat the elderly with non-small cell lung cancer; however, this may increase the risk of treatment failure due to an inadequate dose. It has been shown that compound kushen injection in combination with chemotherapy can enhance the efficacy and reduce the toxicity. The aim of this trial is to assess the clinical effectiveness and safety of compound kushen injection in combination with single-agent chemotherapy versus platinum-based doublet chemotherapy in the treatment of elderly patients with advanced non-small cell lung cancer.

Methods

This multicenter study will be an open-label, randomized controlled trial. Three hundred seventy elderly patients with advanced non-small cell lung cancer will be randomly divided into experimental (n = 185) and control groups (n = 185) to receive compound kushen injection in combination with single-agent chemotherapy or standard platinum-based doublet chemotherapy for two cycles. After two cycles, the disease control rate, objective response rate, clinical symptoms, quality of life, Karnofsky Performance Status, and side effects will be assessed. Follow-up evaluations will be performed every 8 weeks to evaluate the progression-free and overall survival.

Discussion

Before the trial was designed, compound kushen injection was shown to be effective for lung cancer through basic experiments and clinical trials. This study will determine whether or not the efficacy of compound kushen injection in combination with single-agent chemotherapy is comparable to that of platinum-based doublet chemotherapy, and whether or not the toxicity of compound kushen injection in combination with single-agent chemotherapy is lower than that of platinum-based doublet chemotherapy.

Trial registration

ChiCTR-IPR-14005484 (16 November 2014).
Literature
1.
2.
go back to reference Ries LAG, Eisner MP, Kosary CL. SEER Cancer Statistics Review, 1975–2000. Bethesda: National Cancer Institute; 2003. Ries LAG, Eisner MP, Kosary CL. SEER Cancer Statistics Review, 1975–2000. Bethesda: National Cancer Institute; 2003.
3.
go back to reference Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ. Cancer statistics 2007. CA Cancer J Clin. 2007;57:43–66.CrossRefPubMed Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ. Cancer statistics 2007. CA Cancer J Clin. 2007;57:43–66.CrossRefPubMed
4.
go back to reference Owonikoko TK, Ragin CC, Belani CP, Oton AB, Gooding WE, Taioli E, et al. Lung cancer in elderly patients: an analysis of the surveillance, epidemiology, and end results database. J Clin Oncol. 2007;25:5570–7.CrossRefPubMed Owonikoko TK, Ragin CC, Belani CP, Oton AB, Gooding WE, Taioli E, et al. Lung cancer in elderly patients: an analysis of the surveillance, epidemiology, and end results database. J Clin Oncol. 2007;25:5570–7.CrossRefPubMed
5.
go back to reference Wingo PA, Cardinez CJ, Landis SH, Greenlee RT, Ries LA, Anderson RN, et al. Long-term trends in cancer mortality in the United States, 1930-1998. Cancer. 2003;97(12 Suppl):3133–275.CrossRefPubMed Wingo PA, Cardinez CJ, Landis SH, Greenlee RT, Ries LA, Anderson RN, et al. Long-term trends in cancer mortality in the United States, 1930-1998. Cancer. 2003;97(12 Suppl):3133–275.CrossRefPubMed
6.
go back to reference Sörenson S, Glimelius B, Nygren P. SBU-group. Swedish Council of Technology Assessment in Health Care. A systematic overview of chemotherapy effects in non-small cell lung cancer. Acta Oncol. 2001;40:327–39.CrossRefPubMed Sörenson S, Glimelius B, Nygren P. SBU-group. Swedish Council of Technology Assessment in Health Care. A systematic overview of chemotherapy effects in non-small cell lung cancer. Acta Oncol. 2001;40:327–39.CrossRefPubMed
7.
go back to reference Gridelli C, Perrone F, Gallo C, Cigolari S, Rossi A, Piantedosi F, et al. MILES Investigators. Chemotherapy for elderly patients with advanced non-small-cell lung cancer: the Multicenter Italian Lung Cancer in the Elderly Study (MILES) phase III randomized trial. J Natl Cancer Inst. 2003;95:362–72.CrossRefPubMed Gridelli C, Perrone F, Gallo C, Cigolari S, Rossi A, Piantedosi F, et al. MILES Investigators. Chemotherapy for elderly patients with advanced non-small-cell lung cancer: the Multicenter Italian Lung Cancer in the Elderly Study (MILES) phase III randomized trial. J Natl Cancer Inst. 2003;95:362–72.CrossRefPubMed
8.
go back to reference Delbaldo C, Michiels S, Rolland E, Syz N, Soria JC, Le Chevalier T, et al. Second or third additional chemotherapy drug for non-small cell lung cancer in patients with advanced disease. Cochrane Database Syst Rev. 2007;17(4):CD004569. Review. Update in: Cochrane Database Syst Rev. 2012;4:CD004569. Delbaldo C, Michiels S, Rolland E, Syz N, Soria JC, Le Chevalier T, et al. Second or third additional chemotherapy drug for non-small cell lung cancer in patients with advanced disease. Cochrane Database Syst Rev. 2007;17(4):CD004569. Review. Update in: Cochrane Database Syst Rev. 2012;4:CD004569.
9.
go back to reference Liu X, Yang Q, Xi Y, Yu K, Wang W, Zhao X, et al. Kanglaite injection combined with chemotherapy versus chemotherapy alone in the treatment of advanced non-small cell lung carcinoma. J Cancer Res Ther. 2014;10 Suppl 1:46–51.PubMed Liu X, Yang Q, Xi Y, Yu K, Wang W, Zhao X, et al. Kanglaite injection combined with chemotherapy versus chemotherapy alone in the treatment of advanced non-small cell lung carcinoma. J Cancer Res Ther. 2014;10 Suppl 1:46–51.PubMed
10.
go back to reference Dong J, Su SY, Wang MY, Zhan Z. Shenqi fuzheng, an injection concocted from Chinese medicinal herbs, combined with platinum-based chemotherapy for advanced non-small cell lung cancer: a systematic review. J Exp Clin Cancer Res. 2010;29:137.CrossRefPubMedPubMedCentral Dong J, Su SY, Wang MY, Zhan Z. Shenqi fuzheng, an injection concocted from Chinese medicinal herbs, combined with platinum-based chemotherapy for advanced non-small cell lung cancer: a systematic review. J Exp Clin Cancer Res. 2010;29:137.CrossRefPubMedPubMedCentral
11.
go back to reference Yanju B, Yang L, Hua B, Hou W, Shi Z, Li W, et al. A systematic review and meta-analysis on the use of traditional Chinese medicine compound kushen injection for bone cancer pain. Support Care Cancer. 2014;22:825–36.CrossRefPubMed Yanju B, Yang L, Hua B, Hou W, Shi Z, Li W, et al. A systematic review and meta-analysis on the use of traditional Chinese medicine compound kushen injection for bone cancer pain. Support Care Cancer. 2014;22:825–36.CrossRefPubMed
12.
go back to reference Wang N, Zhou YM, Yang ZY. Clinical efficacy of compound kushen injection for advanced non-small-cell lung cancer: Analysis of 80 cases. Evaluation and analysis of drug-use in hospitals of China. 2009;05:387–8. Wang N, Zhou YM, Yang ZY. Clinical efficacy of compound kushen injection for advanced non-small-cell lung cancer: Analysis of 80 cases. Evaluation and analysis of drug-use in hospitals of China. 2009;05:387–8.
13.
go back to reference Dai GH, Chen MM. Synergy and attenuation of compound matrine injection on chemotherapy in patients with advanced lung cancer: A clinic study. Evaluation and analysis of drug-use in hospitals of China. 2010;10:1109–11. Dai GH, Chen MM. Synergy and attenuation of compound matrine injection on chemotherapy in patients with advanced lung cancer: A clinic study. Evaluation and analysis of drug-use in hospitals of China. 2010;10:1109–11.
14.
go back to reference Wei AF, Zhang FE, Lan C, Wei S, Wei JH. Efficacy of composite matrine injection combined with chemotherapy in the treatment of advanced cancer. Chin J New Drugs. 2011;20:1688–90. Wei AF, Zhang FE, Lan C, Wei S, Wei JH. Efficacy of composite matrine injection combined with chemotherapy in the treatment of advanced cancer. Chin J New Drugs. 2011;20:1688–90.
15.
go back to reference Hutchins LF, Unger JM, Crowley JJ, Coltman Jr CA, Albain KS. Underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med. 1999;341:2061–7.CrossRefPubMed Hutchins LF, Unger JM, Crowley JJ, Coltman Jr CA, Albain KS. Underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med. 1999;341:2061–7.CrossRefPubMed
16.
go back to reference Inal A, Kaplan MA, Kucukoner M, Urakci Z, Karakus A, Isikdogan A. Cisplatin-based therapy for the treatment of elderly patients with non-small-cell lung cancer: a retrospective analysis of a single institution. Asian Pac J Cancer Prev. 2012;13:1837–40.CrossRefPubMed Inal A, Kaplan MA, Kucukoner M, Urakci Z, Karakus A, Isikdogan A. Cisplatin-based therapy for the treatment of elderly patients with non-small-cell lung cancer: a retrospective analysis of a single institution. Asian Pac J Cancer Prev. 2012;13:1837–40.CrossRefPubMed
17.
go back to reference Schiller JH, Harrington D, Belani CP, Langer C, Sandler A, Krook J, et al. Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer. N Engl J Med. 2002;346:92–8.CrossRefPubMed Schiller JH, Harrington D, Belani CP, Langer C, Sandler A, Krook J, et al. Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer. N Engl J Med. 2002;346:92–8.CrossRefPubMed
18.
go back to reference Ettinger DS, Akerley W, Borghaei H, Chang AC, Cheney RT, Chirieac LR, et al. Non-small cell lung cancer, version 2.2013. J Natl Compr Canc Netw. 2013;11:645–53.PubMed Ettinger DS, Akerley W, Borghaei H, Chang AC, Cheney RT, Chirieac LR, et al. Non-small cell lung cancer, version 2.2013. J Natl Compr Canc Netw. 2013;11:645–53.PubMed
19.
go back to reference Azzoli CG, Baker Jr S, Temin S, Pao W, Aliff T, Brahmer J, et al. American Society of Clinical Oncology Clinical Practice Guideline update on chemotherapy for stage IV non-small-cell lung cancer. Zhongguo Fei Ai Za Zhi. 2010;13:171–89.PubMed Azzoli CG, Baker Jr S, Temin S, Pao W, Aliff T, Brahmer J, et al. American Society of Clinical Oncology Clinical Practice Guideline update on chemotherapy for stage IV non-small-cell lung cancer. Zhongguo Fei Ai Za Zhi. 2010;13:171–89.PubMed
20.
go back to reference Wolchok JD, Hoos A, O’Day S, Weber JS, Hamid O, Lebbé C, et al. Guidelines for the evaluation of immune therapy activity in solid tumor: immune-related response criteria. Clin Cancer Res. 2009;15:7412–20.CrossRefPubMed Wolchok JD, Hoos A, O’Day S, Weber JS, Hamid O, Lebbé C, et al. Guidelines for the evaluation of immune therapy activity in solid tumor: immune-related response criteria. Clin Cancer Res. 2009;15:7412–20.CrossRefPubMed
21.
go back to reference Cleeland CS, Mendoza TR, Wang XS, Chou C, Harle MT, Morrissey M, et al. Assessing symptom distress in cancer patients: the M.D. Anderson Symptom Inventory. Cancer. 2000;89:1634–46.CrossRefPubMed Cleeland CS, Mendoza TR, Wang XS, Chou C, Harle MT, Morrissey M, et al. Assessing symptom distress in cancer patients: the M.D. Anderson Symptom Inventory. Cancer. 2000;89:1634–46.CrossRefPubMed
22.
go back to reference Zhao Y, Wang XS, Li PP. Investigation of common symptoms of cancer and reliability analysis. Chin J Integr Med. 2007;13:195–9.CrossRefPubMed Zhao Y, Wang XS, Li PP. Investigation of common symptoms of cancer and reliability analysis. Chin J Integr Med. 2007;13:195–9.CrossRefPubMed
23.
go back to reference Wang CH, Chen QM, Zhang CZ, Tang XL, Meng Q, Zhang XP. Evaluation on the quality of life in cancer patients with EORTCQLQ-C30 Chinese Version. J Pract Oncol. 2005;20:353–5. Wang CH, Chen QM, Zhang CZ, Tang XL, Meng Q, Zhang XP. Evaluation on the quality of life in cancer patients with EORTCQLQ-C30 Chinese Version. J Pract Oncol. 2005;20:353–5.
24.
go back to reference Bai H. Manual of tumor diagnosis and treatment for primary physicians. Beijing: Peking University Medical Press; 2008. p. 356. Bai H. Manual of tumor diagnosis and treatment for primary physicians. Beijing: Peking University Medical Press; 2008. p. 356.
26.
go back to reference Tian J, Wang WH, Gao HM, Wang ZM. Determination of matrine, sophoridine and oxymatrine in Compound Kushen Injection by HPLC. Zhongguo Zhong Yao Za Zhi. 2007;32:222–4.PubMed Tian J, Wang WH, Gao HM, Wang ZM. Determination of matrine, sophoridine and oxymatrine in Compound Kushen Injection by HPLC. Zhongguo Zhong Yao Za Zhi. 2007;32:222–4.PubMed
27.
go back to reference Zhang Y, Piao B, Zhang Y, Hua B, Hou W, Xu W, et al. Oxymatrine diminishes the side population and inhibits the expression of β-catenin in MCF-7 breast cancer cells. Med Oncol. 2011;28 Suppl 1:S99–107.CrossRefPubMed Zhang Y, Piao B, Zhang Y, Hua B, Hou W, Xu W, et al. Oxymatrine diminishes the side population and inhibits the expression of β-catenin in MCF-7 breast cancer cells. Med Oncol. 2011;28 Suppl 1:S99–107.CrossRefPubMed
28.
go back to reference Xu W, Lin H, Zhang Y, Chen X, Hua B, Hou W, et al. Compound Kushen Injection suppresses human breast cancer stem-like cells by down-regulating the canonical Wnt/β-catenin pathway. J Exp Clin Cancer Res. 2011;30:103.CrossRefPubMedPubMedCentral Xu W, Lin H, Zhang Y, Chen X, Hua B, Hou W, et al. Compound Kushen Injection suppresses human breast cancer stem-like cells by down-regulating the canonical Wnt/β-catenin pathway. J Exp Clin Cancer Res. 2011;30:103.CrossRefPubMedPubMedCentral
29.
go back to reference Li M, Su BS, Chang LH, Gao Q, Chen KL, An P, et al. Oxymatrine induces apoptosis in human cervical cancer cells through guanine nucleotide depletion. Anticancer Drugs. 2014;25:161–73.CrossRefPubMed Li M, Su BS, Chang LH, Gao Q, Chen KL, An P, et al. Oxymatrine induces apoptosis in human cervical cancer cells through guanine nucleotide depletion. Anticancer Drugs. 2014;25:161–73.CrossRefPubMed
30.
go back to reference Zhao Z, Fan H, Higgins T, Qi J, Haines D, Trivett A, et al. Fufang Kushen injection inhibits sarcoma growth and tumor-induced hyperalgesia via TRPV1 signaling pathways. Cancer Lett. 2014;355:232–41.CrossRefPubMedPubMedCentral Zhao Z, Fan H, Higgins T, Qi J, Haines D, Trivett A, et al. Fufang Kushen injection inhibits sarcoma growth and tumor-induced hyperalgesia via TRPV1 signaling pathways. Cancer Lett. 2014;355:232–41.CrossRefPubMedPubMedCentral
31.
go back to reference Feng YL, Pan SJ, Yang NJ, Yin CC. Meta-analysis on treatment of advanced non-small cell lung cancer with compound matrine injection in combination with Gemcitabine and Cisplatin chemotherapy. Mod J Integr Tradit Chin West Med. 2015;24:2303–6. Feng YL, Pan SJ, Yang NJ, Yin CC. Meta-analysis on treatment of advanced non-small cell lung cancer with compound matrine injection in combination with Gemcitabine and Cisplatin chemotherapy. Mod J Integr Tradit Chin West Med. 2015;24:2303–6.
32.
go back to reference Lu L, Yang H, Teng ZY. Systematic review on compound sophoraflavescens injection adjuvant chemotherapy in the treatment of lung cancer. China Pharm. 2011;24:2267–70. Lu L, Yang H, Teng ZY. Systematic review on compound sophoraflavescens injection adjuvant chemotherapy in the treatment of lung cancer. China Pharm. 2011;24:2267–70.
33.
go back to reference Qin JN. Compound kushen injection combined with chemotherapy for the treatment of elderly advanced non-small cell lung cancer. Contemp Med. 2014;09:132–3. Qin JN. Compound kushen injection combined with chemotherapy for the treatment of elderly advanced non-small cell lung cancer. Contemp Med. 2014;09:132–3.
34.
go back to reference Moher D, Hopewell S, Schulz KF, Montori V, Gøtzsche PC, Devereaux PJ, et al. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. J Clin Epidemiol. 2010;63:e1–37.CrossRefPubMed Moher D, Hopewell S, Schulz KF, Montori V, Gøtzsche PC, Devereaux PJ, et al. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. J Clin Epidemiol. 2010;63:e1–37.CrossRefPubMed
Metadata
Title
A multicenter randomized controlled open-label trial to assess the efficacy of compound kushen injection in combination with single-agent chemotherapy in treatment of elderly patients with advanced non-small cell lung cancer: study protocol for a randomized controlled trial
Authors
Xue-qian Wang
Jie Liu
Hong-sheng Lin
Wei Hou
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Trials / Issue 1/2016
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-016-1231-6

Other articles of this Issue 1/2016

Trials 1/2016 Go to the issue