Ozone Therapy in Chemotherapy-induced Peripheral Neuropathy: RCT (O3NPIQ)

NCT ID: NCT04299893

Last Updated: 2025-09-02

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

PHASE2/PHASE3

Total Enrollment

42 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-11-30

Study Completion Date

2027-12-31

Brief Summary

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The main objective of this clinical trial is to evaluate the effectiveness and cost-effectiveness of adding ozone therapy to the clinical management of patients with pain secondary to chemotherapy-induced peripheral neuropathy

Detailed Description

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Chemotherapy-induced peripheral neuropathy (CIPN) decreases the quality of life of patients and can lead to a decrease and/or interruption of the chemotherapy treatment-limiting its effectiveness. The therapeutic measures for the CIPN are very limited in their number and efficacy.

Main Objectives: 1) To evaluate the clinical effect on the health-related quality of life (HRQOL) of adding ozone to the usual patient´s treatment with persistent pain because of CIPN. 2) Estimate the additional costs and evaluate the cost-effectiveness ratio.

Secondary Objectives: To evaluate the evolution of 3) oxidative stress and chronic inflammation through biochemical measurements; 4) anxiety and depression of patients; 5) the diagnostic and predictive value of hyperspectral imaging in the assessment of pain; 6) the acceptability of patients to a shared decision-making (SDM) tool.

METHODOLOGY: Randomized controlled trial (RCT) phase II-III, randomized, triple-blind; 42 patients with any kind of cancer treated with any kind of chemotherapy, with CIPN of grade \> = 2 for \> = 3 months.

TREATMENT: All patients will receive: usual treatment + 40 rectal insufflation sessions of O3/O2 in 16 weeks:

* Ozone-Arm (n = 21): concentration of O3/O2 increasing from 10 to 30 μg/ml.
* Control-placebo- Arm (n = 21): concentration of O3/O2 = 0 μg/ml.

Main Variables: At the end of treatment with O3/O2 the following variables will be analyzed: 1) "average pain" secondary to CIPN following the Brief Pain Inventory-Short Form (BPI-SF); 2) health-related quality of life (HRQOL) and utilities using EQ-5D-5L and SF-36 quality of life questionnaires; 3) Direct costs.

Secondary Variables: 3) biochemical parameters of oxidative stress and inflammation; 4) Hamilton scale for anxiety and depression; 5) hyperspectral images; 6) acceptability of patients to a shared decision-making (SDM) tool.

Assessments at weeks: 0 (baseline), 16 (end of O3/O2 insufflations, objective), and 28 (end of follow-up, control).

Length of treatment: 16 weeks.

Follow-up: 12 weeks after finishing O3/O2 insufflation.

Planned length of the clinical trial: 36 months.

Conditions

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Chemotherapy-induced Peripheral Neuropathy Pain, Neuropathic Pain Syndrome

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Standard treatment + ozone therapy (O3/O2) versus Standard treatment + oxygen (O2) as placebo
Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors
Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor) Masking of: patients, Medical Oncologists (clinical assessment), investigators obtaining other parameters (quality of life, biochemical and clinical parameters, hyperspectral images), investigators for statistical analysis

Study Groups

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Ozone Group

Drug: Ozone Ozone Group: Usual treatment + Ozone therapy (O3/O2) by rectal insufflation. O3/O2 concentration progressively increased from 10 to 30 μg/ml; 40 sessions in 16 weeks.

Other Names: O3

Group Type EXPERIMENTAL

Ozone

Intervention Type DRUG

Ozone Group: Standard treatment + Ozone therapy (O3/O2) by rectal insufflation. O3/O2 concentration progressively increased from 10 to 30 μg/ml; 40 sessions in 16 weeks.

Control Group

Drug: Oxygen Control Group: Standard treatment + Oxygen (O2) by rectal insufflation. O3/O2 concentration = 0 μg/ml (only O2); 40 sessions in 16 weeks.

Other Names: O2

Group Type PLACEBO_COMPARATOR

Oxygen

Intervention Type DRUG

Control Group: Standard treatment + Oxygen (O2) by rectal insufflation. O3/O2 concentration = 0 μg/ml (only O2); 40 sessions in 16 weeks.

Interventions

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Oxygen

Control Group: Standard treatment + Oxygen (O2) by rectal insufflation. O3/O2 concentration = 0 μg/ml (only O2); 40 sessions in 16 weeks.

Intervention Type DRUG

Ozone

Ozone Group: Standard treatment + Ozone therapy (O3/O2) by rectal insufflation. O3/O2 concentration progressively increased from 10 to 30 μg/ml; 40 sessions in 16 weeks.

Intervention Type DRUG

Other Intervention Names

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O3 O2

Eligibility Criteria

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Inclusion Criteria

* 1\. Adults \> = 18 years old.
* 2\. Any kind of cancer in any stage, treated with any kind of chemotherapy, and life expectancy \> = 6 months.
* 3\. Clinical diagnosis of painful chemotherapy-induced peripheral neuropathy, toxicity Grade 2 or higher according to the Common Toxicity Criteria for Adverse Events (CTCAE) from the National Cancer Institute of EEUU, v.5.0, for \> = 3 months and without the inclusion of new treatments for pain and/or neuropathy for \> = 1 month.
* 4\. "Average pain" \> = 3/10 according to the Brief Pain Inventory-Short Form (BPI-SF) \> = 3 months beyond chemotherapy completion.
* 5\. Pregnant women cannot participate in the clinical trial.
* 6\. Before enrollment, women of childbearing potential should obtain a negative result in the serum or urine pregnancy test at the screening visit and accept the use of appropriate contraceptive methods at least from the 14 days prior to the first ozone therapy session up to 14 days after the last one.
* 7\. Patients who have signed and dated the study 's specific informed consent

Exclusion Criteria

* 1\. Age \< 18 years old.
* 2\. Pregnancy at the time of enrollment.
* 3\. Women with childbearing potential who are unwilling to perform a pregnancy test and/or employ adequate contraception from the 14 days prior to the first ozone therapy session up to 14 days after the last one.
* 4\. Clinical suspicion that peripheral neuropathy (compressive or diabetic neuropathy) in the same area prior to receiving neurotoxic chemotherapy.
* 5\. Psychiatric illness or social situations that would limit compliance with study requirements.
* 6\. Those who are unable to fill in the scales used to measure quality of life variables
* 7\. Specific liver enzymes \[Aspartate Aminotransferase (AST), and Alanine Aminotransferase (ALT) \> 5 times the upper limit of normal
* 8\. Increased creatinine \> 3 times the upper limit of normal.
* 9\. Hemodynamically or clinically unstable patients or uncontrolled severe illness.
* 10\. Uncontrolled cancer disease.
* 11\. Leptomeningeal carcinomatosis.
* 12\. Life expectancy \< 6 months
* 13\. Contraindication or disability for rectal ozone administration or to attend scheduled treatments.
* 14\. Known allergy to ozone.
Minimum Eligible Age

18 Years

Maximum Eligible Age

100 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Servicio Canario de Salud

OTHER

Sponsor Role collaborator

Instituto de Salud Carlos III

OTHER_GOV

Sponsor Role collaborator

Red de Investigación en Servicios de Salud en Enfermedades Crónicas

OTHER

Sponsor Role collaborator

Fundación DISA, Spain

UNKNOWN

Sponsor Role collaborator

Fundación Española del Dolor (FED)

UNKNOWN

Sponsor Role collaborator

Bernardino Clavo, MD, PhD

OTHER

Sponsor Role lead

Responsible Party

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Bernardino Clavo, MD, PhD

MD, PhD, Head of Research Unit

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Bernardino Clavo, MD, PhD

Role: STUDY_CHAIR

Dr. Negrín University Hospital, Las Palmas, Spain

Pedro G Serrano-Aguilar, MD, PhD

Role: STUDY_DIRECTOR

Servicio de Evaluación. Servicio Canario de Salud. Spain

Delvys Rodríguez-Abreu, MD

Role: PRINCIPAL_INVESTIGATOR

Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas, Spain

Gustavo M Callico, Prof, PhD

Role: PRINCIPAL_INVESTIGATOR

Institute for Applied Microelectronics, University of Las Palmas de G. C., Spain

Francisco Rodríguez-Esparragón, BSc, PhD

Role: PRINCIPAL_INVESTIGATOR

Dr. Negrín University Hospital, Las Palmas, Spain

Bernardino Clavo, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Dr. Negrín University Hospital, Las Palmas, Spain

Locations

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Complejo Hospitalario Materno Insular

Las Palmas de Gran Canaria, Las Palmas, Spain

Site Status RECRUITING

Hospital Universitario de Gran Canaria Dr. Negrín

Las Palmas de Gran Canaria, Las Palmas, Spain

Site Status RECRUITING

Countries

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Spain

Central Contacts

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Bernardino Clavo, MD, PhD

Role: CONTACT

(34)928449278

Delvys Rodríguez-Abreu, MD

Role: CONTACT

(34)928441779

Facility Contacts

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Delvys Rodríguez-Abreu, MD

Role: primary

Bernardino Clavo, MD, PhD

Role: primary

References

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Smith EM, Pang H, Cirrincione C, Fleishman S, Paskett ED, Ahles T, Bressler LR, Fadul CE, Knox C, Le-Lindqwister N, Gilman PB, Shapiro CL; Alliance for Clinical Trials in Oncology. Effect of duloxetine on pain, function, and quality of life among patients with chemotherapy-induced painful peripheral neuropathy: a randomized clinical trial. JAMA. 2013 Apr 3;309(13):1359-67. doi: 10.1001/jama.2013.2813.

Reference Type BACKGROUND
PMID: 23549581 (View on PubMed)

Durand JP, Deplanque G, Montheil V, Gornet JM, Scotte F, Mir O, Cessot A, Coriat R, Raymond E, Mitry E, Herait P, Yataghene Y, Goldwasser F. Efficacy of venlafaxine for the prevention and relief of oxaliplatin-induced acute neurotoxicity: results of EFFOX, a randomized, double-blind, placebo-controlled phase III trial. Ann Oncol. 2012 Jan;23(1):200-205. doi: 10.1093/annonc/mdr045. Epub 2011 Mar 22.

Reference Type BACKGROUND
PMID: 21427067 (View on PubMed)

Albers JW, Chaudhry V, Cavaletti G, Donehower RC. Interventions for preventing neuropathy caused by cisplatin and related compounds. Cochrane Database Syst Rev. 2014 Mar 31;2014(3):CD005228. doi: 10.1002/14651858.CD005228.pub4.

Reference Type BACKGROUND
PMID: 24687190 (View on PubMed)

Hershman DL, Lacchetti C, Dworkin RH, Lavoie Smith EM, Bleeker J, Cavaletti G, Chauhan C, Gavin P, Lavino A, Lustberg MB, Paice J, Schneider B, Smith ML, Smith T, Terstriep S, Wagner-Johnston N, Bak K, Loprinzi CL; American Society of Clinical Oncology. Prevention and management of chemotherapy-induced peripheral neuropathy in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2014 Jun 20;32(18):1941-67. doi: 10.1200/JCO.2013.54.0914. Epub 2014 Apr 14.

Reference Type BACKGROUND
PMID: 24733808 (View on PubMed)

Bocci V, Borrelli E, Travagli V, Zanardi I. The ozone paradox: ozone is a strong oxidant as well as a medical drug. Med Res Rev. 2009 Jul;29(4):646-82. doi: 10.1002/med.20150.

Reference Type BACKGROUND
PMID: 19260079 (View on PubMed)

Bocci VA, Zanardi I, Travagli V. Ozone acting on human blood yields a hormetic dose-response relationship. J Transl Med. 2011 May 17;9:66. doi: 10.1186/1479-5876-9-66.

Reference Type BACKGROUND
PMID: 21575276 (View on PubMed)

Bocci V, Valacchi G. Nrf2 activation as target to implement therapeutic treatments. Front Chem. 2015 Feb 2;3:4. doi: 10.3389/fchem.2015.00004. eCollection 2015.

Reference Type BACKGROUND
PMID: 25699252 (View on PubMed)

Clavo B, Ceballos D, Gutierrez D, Rovira G, Suarez G, Lopez L, Pinar B, Cabezon A, Morales V, Oliva E, Fiuza D, Santana-Rodriguez N. Long-term control of refractory hemorrhagic radiation proctitis with ozone therapy. J Pain Symptom Manage. 2013 Jul;46(1):106-12. doi: 10.1016/j.jpainsymman.2012.06.017. Epub 2012 Oct 26.

Reference Type BACKGROUND
PMID: 23102757 (View on PubMed)

Clavo B, Rodriguez-Esparragon F, Rodriguez-Abreu D, Martinez-Sanchez G, Llontop P, Aguiar-Bujanda D, Fernandez-Perez L, Santana-Rodriguez N. Modulation of Oxidative Stress by Ozone Therapy in the Prevention and Treatment of Chemotherapy-Induced Toxicity: Review and Prospects. Antioxidants (Basel). 2019 Nov 26;8(12):588. doi: 10.3390/antiox8120588.

Reference Type BACKGROUND
PMID: 31779159 (View on PubMed)

Clavo B, Martinez-Sanchez G, Rodriguez-Esparragon F, Rodriguez-Abreu D, Galvan S, Aguiar-Bujanda D, Diaz-Garrido JA, Canas S, Torres-Mata LB, Fabelo H, Tellez T, Santana-Rodriguez N, Fernandez-Perez L, Marrero-Callico G. Modulation by Ozone Therapy of Oxidative Stress in Chemotherapy-Induced Peripheral Neuropathy: The Background for a Randomized Clinical Trial. Int J Mol Sci. 2021 Mar 10;22(6):2802. doi: 10.3390/ijms22062802.

Reference Type BACKGROUND
PMID: 33802143 (View on PubMed)

Clavo B, Navarro M, Federico M, Borrelli E, Jorge IJ, Ribeiro I, Rodriguez-Melcon JI, Carames MA, Santana-Rodriguez N, Rodriguez-Esparragon F. Ozone Therapy in Refractory Pelvic Pain Syndromes Secondary to Cancer Treatment: A New Approach Warranting Exploration. J Palliat Med. 2021 Jan;24(1):97-102. doi: 10.1089/jpm.2019.0597. Epub 2020 May 5.

Reference Type BACKGROUND
PMID: 32379556 (View on PubMed)

Clavo B, Navarro M, Federico M, Borrelli E, Jorge IJ, Ribeiro I, Rodriguez-Melcon JI, Carames MA, Santana-Rodriguez N, Rodriguez-Esparragon F. Long-Term Results with Adjuvant Ozone Therapy in the Management of Chronic Pelvic Pain Secondary to Cancer Treatment. Pain Med. 2021 Sep 8;22(9):2138-2141. doi: 10.1093/pm/pnaa459. No abstract available.

Reference Type BACKGROUND
PMID: 33738491 (View on PubMed)

Clavo B, Rodriguez-Abreu D, Galvan S, Federico M, Martinez-Sanchez G, Ramallo-Farina Y, Antonelli C, Benitez G, Rey-Baltar D, Jorge IJ, Rodriguez-Esparragon F, Serrano-Aguilar P. Long-term improvement by ozone treatment in chronic pain secondary to chemotherapy-induced peripheral neuropathy: A preliminary report. Front Physiol. 2022 Aug 30;13:935269. doi: 10.3389/fphys.2022.935269. eCollection 2022.

Reference Type BACKGROUND
PMID: 36111149 (View on PubMed)

Other Identifiers

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PI 19/00458

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

016/2019

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

BF1-19-03

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

2019-000821-37

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

2018-156-1

Identifier Type: -

Identifier Source: org_study_id

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