Netupitant/Palonosetron Hydrochloride and Dexamethasone With or Without Prochlorperazine or Olanzapine in Improving Chemotherapy-Induced Nausea and Vomiting in Patients With Breast Cancer
Netupitant/Palonosetron Hydrochloride and Dexamethasone With or Without Prochlorperazine or Olanzapine in Improving Chemotherapy-Induced Nausea and Vomiting in Patients With Breast Cancer
This randomized phase III trial studies how well netupitant/palonosetron hydrochloride and
 dexamethasone with prochlorperazine or olanzapine work compared to netupitant/palonosetron
 hydrochloride and dexamethasone in improving chemotherapy-induced nausea and vomiting in
 patients with breast cancer. Antiemetic drugs, such as prochlorperazine and olanzapine, may
 help lessen nausea and vomiting in patients with breast cancer treated with chemotherapy.
PRIMARY OBJECTIVES:

 I. To determine if control of nausea at cycle 2 in participants who experienced
 chemotherapy-induced nausea and vomiting (CINV) at cycle 1 is improved by the addition of
 either prochlorperazine or olanzapine to the control arm of netupitant, palonosetron and
 dexamethasone.

 SECONDARY OBJECTIVES:

 I. To determine if olanzapine is more effective than prochlorperazine in controlling nausea
 at cycle 2 in participants who experienced CINV at cycle 1 when used in combination with
 netupitant, palonosetron and dexamethasone.

 II. To determine if control of vomiting at cycle 2 in patients who experienced CINV at cycle
 1 is improved by the addition of either prochlorperazine or olanzapine to the control arm of
 netupitant, palonosetron and dexamethasone.

 III. To determine if olanzapine is more effective than prochlorperazine in controlling
 vomiting at cycle 2 in participants who experienced CINV at cycle 1 when used in combination
 with netupitant, palonosetron and dexamethasone.

 TERTIARY OBJECTIVES:

 I. To create an empirically-based algorithm predicting nausea from breast cancer chemotherapy
 regimens that takes into account not only state-of-the-art anti-emetic regimens but also
 participant factors such as age, race, education, ethnicity, quality of life (QOL), alcohol
 consumption, susceptibility to nausea, expectancy, anxiety, level of nausea on the day prior
 to treatment, and prior history of nausea.

 II. To compare the effects of the interventions on QOL, as assessed by the Functional
 Assessment of Cancer Therapy- General (FACT-G), by following the same procedures described
 under the primary aim and the first secondary aim, using change in the FACT-G scores as the
 response.

 III. To provide preliminary data on the frequency and severity of sleep disturbance, fatigue,
 anxiety, and dizziness, across treatment conditions.

 IV. To provide preliminary data on biological factors (e.g. glutathione [GSH] recycling,
 genetic markers) that may help identify a subgroup of patients at high risk for development
 of cancer-related or treatment-related side effects, or response to treatment.

 OUTLINE:

 PART I: Patients receive 1 cycle of standard of care chemotherapy.

 PART II: Patients with a nausea score >= 3 at least once on the diary at cycle 1 chemotherapy
 are randomized into 1 of 3 groups at cycle 2.

 GROUP I: Within 1 hour prior to chemotherapy, patients receive netupitant/palonosetron
 hydrochloride orally (PO) on day 1. Within 30 minutes prior to chemotherapy, patients also
 receive dexamethasone PO on days 1-4. Patients also receive placebo PO with chemotherapy
 every 8 hours (Q8H) on days 1-4.

 GROUP II: Patients receive netupitant/palonosetron hydrochloride and dexamethasone as in
 Group I. Patients also receive prochlorperazine PO Q8H and placebo PO with chemotherapy on
 days 1-4.

 GROUP III: Patients receive netupitant/palonosetron hydrochloride and dexamethasone as in
 Group I. Patients also receive olanzapine PO and placebo PO Q8H with chemotherapy on days
 1-4.

 After completion of study treatment, patients are followed up for 30 days.
Inclusion Criteria:

 -  Have a diagnosis of breast cancer and be chemotherapy naive; NOTE: prior methotrexate
 for non-cancerous conditions is allowed

 -  Be scheduled to receive a single-day chemotherapy regimen that contains doxorubicin
 and/or cyclophosphamide and/or carboplatin; Herceptin (trastuzumab) and other
 chemotherapy agents will be allowed with any of these regimens

 -  Be scheduled to receive an antiemetic regimen that does not contain Akynzeo; in
 addition, the antiemetic regimen must conform with American Society of Clinical
 Oncology (ASCO) Clinical Practice Guidelines at cycle 1

 -  Be able to read English

 -  Have the ability to give written informed consent

 -  Have Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2

 -  NOTE: patients 80 years of age or older must have approval from an oncologist or their
 designee to participate in this study

 -  NOTE: patients currently receiving warfarin must have approval from an oncologist or
 their designee to participate in this study

 -  Women of child-bearing potential must agree to use adequate contraception (hormonal or
 barrier method of birth control, or abstinence) for the duration of the study and have
 a negative pregnancy test within 10 days prior to the initiation of chemotherapy;
 should a woman become pregnant or suspect she is pregnant while participating in this
 study, she should inform her study physician immediately

 -  CYCLE II PORTION ONLY: Only participants with a nausea score >= 3 at least once on the
 diary assessment from cycle 1 can be randomized for cycle 2

 -  CYCLE II PORTION ONLY: Participants must be scheduled to receive the same chemotherapy
 regimen as received at cycle 1

 Exclusion Criteria:

 -  Have clinical evidence of current or impending bowel obstruction

 -  Have a known history of central nervous system disease (e.g., brain metastases or a
 seizure disorder)

 -  Have dementia

 -  Have uncontrolled diabetes mellitus or uncontrolled hyperglycemia

 -  Have severe hepatic impairment, severe renal impairment, or end-stage renal disease as
 determined by the treating physician

 -  Have had long term treatment (> 5 days within the past 30 days) with an antipsychotic
 agent such as risperidone, quetiapine, clozapine, a phenothiazine, or a butyrophenone
 within 30 days before enrollment or plans for such treatment during the study period;
 NOTE: participants could have received prochlorperazine and other phenothiazines as
 antiemetic therapy on a short term basis (i.e., =< 5 days)

 -  Have a known cardiac arrhythmia, uncontrolled congestive heart failure, or acute
 myocardial infarction within the previous 6 months

 -  Be taking benzodiazepines regularly (> 5 days within the past 30 days); pro re nata
 (PRN) use (=< 5 days) for the short-term relief of the symptoms of anxiety, anxiety
 associated with depressive symptoms, or as a rescue medication for breakthrough CINV
 is allowed

 -  Be taking anticholinergic medications

 -  Be receiving quinolone antibiotic therapy

 -  Be taking amifostine (Ethiofos)

 -  Have a known hypersensitivity to olanzapine or to phenothiazines

 -  CYCLE II PORTION ONLY: Must not have received Akynzeo at cycle 1

 -  CYCLE II PORTION ONLY: Must still meet all the exclusion criteria for cycle 1