Auricular Point Stimulation Plus Dexamethasone Versus Standard Antiemetic Regimen for Nausea and Vomiting Caused by Trastuzumab Deruxtecan

This study aims to evaluate whether the preventive and suppressive effects of auricular point stimulation combined with dexamethasone on nausea and vomiting induced by trastuzumab deruxtecan are non-inferior to the standard antiemetic regimen in breast cancer palliative therapy. Additionally, it will assess patients' appetite, gastrointestinal function, and other related indicators, and explore the significant role of integrated traditional Chinese medicine and Western medicine interventions in improving patients' quality of life during anti-cancer treatment, thereby providing a clinical reference for optimizing the management of adverse reactions of trastuzumab deruxtecan treatment. The main questions it aims to answer are: Whether the preventive and suppressive effects of auricular point stimulation combined with dexamethasone on nausea and vomiting induced by trastuzumab deruxtecan are non-inferior to the standard antiemetic regimen? In comparison with a standard pharmacologic antiemetic regimen, does auricular point stimulation plus dexamethasone effectively reduce the incidence of appetite loss, weakened or disordered gastrointestinal function, and other uncomfortable conditions? Breast cancer patients receiving palliative treatment with trastuzumab deruxtecan will be randomly assigned in a 1:1 ratio to either the auricular point stimulation group or the standard pharmacologic antiemetic regimen group. Patients in the auricular point stimulation group will: Receive auricular acupressure with bean seeds on specific points of one ear, plus intravenous injection of dexamethasone as a preventive antiemetic treatment within half an hour before trastuzumab deruxtecan injection. Starting from the day of trastuzumab deruxtecan injection (Day 1) to the following five days (Day 1-Day 5), provide regular stimulation at the acupressure points daily by themselves according to the protocol provided in this trial. Record their nausea and vomiting status, appetite, and gastrointestinal function-related symptomatic indicators from Day 1 to Day 5. Oral antiemetics are also prepared. If nausea and vomiting are significant or the patient feels the need, they may be temporarily administered as an adjunct. Patients in the standard pharmacologic antiemetic regimen group will: Receive the standard pharmacologic antiemetic regimen chosen by their physicians according to clinical guidelines.

Sex

All

Minimum age

18 Years

Maximum age

85 Years

Inclusion Criteria:

* Patients must meet the following inclusion criteria for the study: \* Age ≥ 18 years and ≤ 85 years; \* Breast cancer patients scheduled to undergo palliative treatment with trastuzumab deruxtecan; \* ECOG performance status score of 0-2; \* Normal hematological function (platelet count \> 80×10⁹/L; white blood cell count \> 3×10⁹/L; neutrophil count \> 1.5×10⁹/L); \* Serum bilirubin ≤ 1.5 times the upper limit of normal (ULN), and transaminase ≤ 5 times the ULN; \* No ascites, no gastrointestinal obstruction, normal coagulation function, and serum albumin ≥ 30g/L; \* Child-Pugh classification of liver function is Grade A; \* Serum creatinine \< ULN, or calculated creatinine clearance rate \> 50ml/min.

Exclusion Criteria:

* Patients who meet any of the following criteria will be excluded from the study: \* Local inflammation or infection of the auricle; \* Bleeding tendency or coagulation disorders; \* Severe ascites; \* Gastrointestinal obstruction; \* Hypertensive crisis or hypertensive encephalopathy; \* Severe uncontrolled systemic complications such as infection or diabetes mellitus; \* Clinically severe cardiovascular diseases, including cerebrovascular accident (within 6 months before enrollment), myocardial infarction (within 6 months before enrollment), hypertension that is not well-controlled despite appropriate medication, unstable angina pectoris, congestive heart failure (NYHA Class 2-4), and cardiac arrhythmias requiring drug treatment; \* A history of or physical examination findings indicating central nervous system diseases (e.g., primary brain tumor, epilepsy uncontrolled by standard treatment, any history of brain metastasis or stroke); \* Hypersensitivity to any drugs used in the study; \* Pregnant or lactating women; \* Presence of any other diseases, functional impairment caused by metastatic lesions, or suspicious disorders identified during physical examination, which suggest contraindications to the study drugs or place the patient at high risk of treatment-related complications; \* Inability or unwillingness to comply with the study protocol.

• BACKGROUNDStankowicz M, Mauro L, Harnden K, Pennisi A. Management of Chemotherapy-Induced Nausea and Vomiting with Trastuzumab Deruxtecan: A Case Series. Breast Care (Basel). 2021 Aug;16(4):408-411. doi: 10.1159/000511049. Epub 2020 Oct 23. PMID 34602948