Patient case: 50-year-old female with Lung cancer. Genetic variant: EGFR (L858R). Other conditions: Lupus.

Clinical trial: Aprepitant vs. Desloratadine in EGFR-TKIs Related Pruritus Treatment

Summary: Study hypothesis is that aprepitant is more effective than desloratadine in relieving pruritus caused by EGFR TKIs. Primary endpoint is the effective rate of pruritus, effective treatment defined as visual analogue scale (VAS) decrease ≥ 50% after treatment compared to baseline score. 130 NSCLC patients undertaken EGFR-TKI and suffer from moderate or severe pruritus (VAS score ≥ 4) will be enrolled in this study, and stratified (gender, first or seconde generation TKIs, VAS 4-6 or 7-10) randomized (1:1) into aprepitant or desloratadine treatment. VAS investigation will be taken once a week to treatment end or follow-up end (≤12 weeks).

Detailed description: This is a prospective, randomized control, double-blinded, phase II clinical trial. Study hypothesis is that aprepitant is more effective than desloratadine in relieving pruritus caused by EGFR TKIs. Primary endpoint is the effective rate of pruritus, effective treatment defined as visual analogue scale (VAS) decrease ≥ 50% after treatment compared to baseline score. Secondary endpoints are the duration of pruritus relieving, defined as the time from pruritus effective relief to VAS score increase ≥ baseline level, the VAS inquiry will be taken once a week, treatment last for 28 days unless pruritus recurrence or discontinuation of EGFR-TKI. Quality of life investigation will be performed at baseline, treatment end and follow-up end using SKINDEX-16 questionnaire. 130 NSCLC patients undertaken EGFR-TKI and suffer from moderate or severe pruritus (VAS score ≥ 4) will be enrolled in this study, and stratified (gender, first or seconde generation TKIs, VAS 4-6 or 7-10) randomized (1:1) into aprepitant or desloratadine treatment. Aprepitant arm will be administrated aprepitant 125mg d1, 80mg d3 and d5, along with placebo 5mg d1-d28; desloratadine arm will be administrated placebo 125mg d1, 80mg d3 and d5, along with desloratadine 5mg d1-d28. Tolerance evaluation will be taken according to National Cancer Institute (NCI)-Common Terminology Criteria (CTC) For Adverse Events (AE) V4.03. Treatment end in d28, VAS investigation will be taken once a week to treatment end, if the treatment is not effective, patients will be unblinded and receive other treatment decided by investigator. If the treatment is effective, follow-up will be taken up to 12 weeks

Eligibility: Inclusion Criteria:
  -  Advanced or metastatic non small cell lung cancer
  -  Harboured with positive EGFR mutation (19del, 21L858R, 21861Q, etc)
  -  Undertaken EGFR TKIs treatment (gefitinib, erlotinib, icotinib, afatinib, etc)
  -  18 years old
  -  Eastern Cooperative Oncology Group (ECOG) performance score 0-2
  -  Moderate or severe pruritus (VAS score ≥ 4) first occur after EGFR TKIs treatment
  -  Life expectancy ≥ 3 months
  -  Orally drug administration with no difficulty
  -  pregnancy test negative in 7 days for women of child-bearing age; willing to take contraception measures.
  -  Signed informed consent form (ICF)
  Exclusion Criteria:
  -  Systemically treatment with Neurokinin-1 (NK-1) receptor inhibitors, antihistamines drugs, antibiotics, cortical hormone therapy, antiepileptic drugs, immunosuppressive agents or other drugs might affect treatment in 4 weeks; or locally used of these drug in 2 weeks.
  -  Existing skin lesions not EGFR TKIs related, such as skin infection, chronic dermatitis, Systemic Lupus Erythematosus (SLE), lymphoma or other diseases.
  -  Total bilirubin ≥ 1.5 Upper Limit Of Normal (ULN)
  -  Serum creatinine ≥mg/dl
  -  AST or ALT ≥ 2.5 ULN without liver metastasis; or ≥ 5 ULN with liver metastasis.
  -  Residual toxicity event ≥ CTC-AE grade 2, except peripheral neurotoxicities.
  -  Central nervous system (CNS) metastasis or spinal compression; except no symptoms and with no cortical hormonotherapy in 4 weeks.
  -  Clinical evidence of interstitial lung disease
  -  Any severe or uncontrolled systemic diseases judged by investigators.
  -  Any contraindication of Neurokinin-1 receptor inhibitors and desloratadine.
  Discontinuation Criteria
  -  Invalid subject after randomization
  -  Major protocol violations judged by investigators.
  -  Poor compliance
  -  Intolerable adverse events
  -  Subject withdraw ICF
  -  Any pregnancy events
  -  No clinical benefits due to clinical adverse events, laboratory abnormalities or other medical conditions
  -  Other reasons of treatment discontinuation judged by investigators.

Relevance to patient case: not relevant