Could you give us a bit of background to the research?
Our study was conceived about ten years ago, looking for a pharmacological intervention for cancer-related fatigue. All the previous pharmaceutical agents like antidepressants and methylphenidate, which give energy, had previously failed and we were looking for a different type of candidate. We looked at this unique candidate, bupropion, with the reports that it gives energy rather than creates fatigue, and thought this might make an ideal candidate for cancer-related fatigue.
Could you outline the methodology?
This was a phase III, placebo-blinded, multicentre, randomised controlled trial. It was conducted through a network called NCORP, and that’s sponsored by the National Cancer Institute, that’s a collection of community-based oncology groups, not academic medical centres that you would see at a large academic institute. This is where the majority of Americans get treated and they represent almost all 50 countries, so they were recruited from across the United States as a whole. We recruited 428 patients and our retention rate was right around 83%.
What did you find?
We found that with 12 weeks of standard bupropion, where we started you off at 150mg, escalating to 300mg, which is the standard dose which we use commonly in smoking cessation and things like that, we found a statistically significant improvement in fatigue of about two points. Now, while that was statistically significant, it wasn’t quite clinically meaningful. We were aiming for a three-point difference and we had a two-point difference.
However, when we looked by sex, women had a three-point difference and these women composed 83% of our sample. So we met our statistical endpoint and we met our clinically meaningful endpoint in women.
What impact could these findings have and what’s next?
This is the first phase III placebo-controlled trial where we have a pharmaceutical agent that successfully improved fatigue. So right now we are just analysing all the data. We have to look at the mechanisms behind it, we looked at inflammation and we found no difference in inflammation so we know it’s not that mechanism. We have a number of other biological mechanisms to try to uncover how and who this is working in.
