Effect of Multi-modal Intervention Care on Cachexia in Patients With Advanced Cancer Compared to Conventional Management (MIRACLE)

NCT ID: NCT04907864

Last Updated: 2021-06-01

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

UNKNOWN

Clinical Phase

PHASE2

Total Enrollment

112 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-01-31

Study Completion Date

2022-06-30

Brief Summary

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Background

Cancer Cachexia (CC) is a multi-factorial process characterized by progressive weight loss, muscle mass and fat tissue wasting, and adversely affecting their quality of life and survival in patients with advanced stage of cancer.

Megestrol acetate (MA), which can help maintain body weight in advanced cancer patients, has not been proven to be effective in improving quality of life or lean body mass. Furthermore, its use is often limited due to various adverse event such as Cushing syndrome, adrenal insufficiency, or thromboembolic risk.

CC has a complex and multi-factorial pathophysiology, and there is no established standard treatment.

Hypothesis CC is irreversible once it occurs and is also difficult to suppress its progression with any single treatment modality.

The investigators hypothesized that a multi-modal intervention comprised of anti-inflammation, omega-3-fatty acids, oral nutritional supplement with counselling by nutritionist, physical exercise, psychiatric intervention as well as Bojungikki-tang which mediates immune-modulation and reverse both of chronic inflammation and wasting condition as a complementary and alternative medicine (CAM) could prevent the development of CC or improve the CC in advanced cancer patients during chemotherapy compared to those who received usual supportive.

Detailed Description

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\[PICOT\] Population: Patients with recurrent or metastatic solid cancer (gastric, colorectal, pancreas, biliary tract and lung)

Intervention: Multimodal treatment

Comparison: Conventional palliative care

Outcome: Change of total lean body mass, Change of handgrip strength Time: 12 weeks of study period for each subject during the first- or second-line palliative chemotherapy

Conditions

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Gastric Cancer Colorectal Cancer Pancreatic Cancer Biliary Tract Cancer Lung Cancer Precachexia Cachexia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

An open-label, randomized phase 2 trial
Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

NONE

Study Groups

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MIC

Multi-modal intervention

Group Type EXPERIMENTAL

Multi-modal intervention

Intervention Type COMBINATION_PRODUCT

Daily oral medications: ibuprofen 400 mg three times a day, omega-3-fatty acid 1 g twice a day, Bojungikki-tang 3.75g twice a day, oral nutritional supplement (HAMONILAN SOLN) 200 ml twice a day Weekly physical exercise by physiatrist (60 minutes per visit) Biweekly psychiatric intervention Nutritional counselling total four times during the study period

CPC

Conventional Palliative Care

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Multi-modal intervention

Daily oral medications: ibuprofen 400 mg three times a day, omega-3-fatty acid 1 g twice a day, Bojungikki-tang 3.75g twice a day, oral nutritional supplement (HAMONILAN SOLN) 200 ml twice a day Weekly physical exercise by physiatrist (60 minutes per visit) Biweekly psychiatric intervention Nutritional counselling total four times during the study period

Intervention Type COMBINATION_PRODUCT

Other Intervention Names

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ibuprofen (Brufen) omega-3-fattyacid (Omacor) Bojungikki-tang (Kracie Bojungikgitang Extract Fine Granule) oral nutritionalsupplement (HARMONILAN SOLN)

Eligibility Criteria

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Inclusion Criteria

* Patients over 19 years of age
* Patients diagnosed with gastrointestinal (stomach, esophageal, direct colon, liver, pancreatic biliary tract) cancer and lung cancer
* Patients receiving first- or second-line palliative chemotherapy
* ECOG PS 0-2
* Patients who were classified as normal, precachexia or cachexia according to the cachexia classification criteria

* Normal: Neither pre-cachexia Nor cachexia
* Precachexia: Weight loss ≤5%, Anorexia or glucose intolerance in last 6 months
* Cachexia: Weight loss \>5%, or BMI \<20 with weight loss \>2% in last 6 months
* Adequate organ functions

Exclusion Criteria

* Patients with history of heart failure or currently being treated for heart failure
* Patients with SBP of 160 mmHg or higher or DBP of 100 mmHg or higher despite antihypertensive medication
* Patients with or have a history of bronchial asthma
* Patients with bowel obstruction
* Patients who have taken appetite stimulants or anabolic or anti-catabolic agents (eg. Megestrol acetate, progestational agents, etc.) within 30 days prior to the study enrollment
* Patients who received steroid treatment (\> 10 mg/d prednisolone or equivalent) within 3 months prior to the study enrollment
* Patients who have taken nonsteroidal anti-inflammatory drugs or aspirin continuously for more than 1 week
* Patients with problems with taking non-steroidal anti-inflammatory drugs (NSAIDs) or those with uncontrolled diabetes due to digestive system diseases (gastric ulcer, gastrointestinal bleeding, etc.)
* Patients who are pregnant or breastfeeding, who have not used proper contraception (oral, injection, infusion or hormonal contraceptive methods, intrauterine devices and blocking methods)
* Patients who are taking anticoagulants (e.g. warfarin or heparin)
* Patients who have difficulty in oral administration
* Patients who have a history of hypersensitivity reactions such as asthma, hives, or allergic reactions to drugs containing ibuprofen, aspirin, and other nonsteroidal anti-inflammatory drugs (including COX-2 inhibitors)
* Patients who showed clinically significant hypersensitivity reactions to investigational products
Minimum Eligible Age

19 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Research Foundation of Korea

OTHER

Sponsor Role collaborator

Kil Yeon Lee

OTHER

Sponsor Role lead

Responsible Party

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Kil Yeon Lee

Professor

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Kil Yeon Lee, M.D.

Role: PRINCIPAL_INVESTIGATOR

Kyung Hee University Hospital

Locations

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Kyung Hee University Hospital

Seoul, , South Korea

Site Status RECRUITING

Countries

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South Korea

Central Contacts

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Chi Hoon Maeng, M.D.

Role: CONTACT

+82-2-958-2965

Bo-Hyung Kim, M.D.

Role: CONTACT

+82-2-958-9326

Facility Contacts

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Chi Hoon Maeng, M.D.

Role: primary

+82-2-958-2965

Bo-Hyung Kim, M.D.

Role: backup

+82-2-958-9326

References

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Maeng CH, Kim BH, Chon J, Kang WS, Kang K, Woo M, Hong IK, Lee J, Lee KY. Effect of multimodal intervention care on cachexia in patients with advanced cancer compared to conventional management (MIRACLE): an open-label, parallel, randomized, phase 2 trial. Trials. 2022 Apr 11;23(1):281. doi: 10.1186/s13063-022-06221-z.

Reference Type DERIVED
PMID: 35410294 (View on PubMed)

Other Identifiers

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KHMC-HUMANITAS-01

Identifier Type: -

Identifier Source: org_study_id

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