Electro-acupuncture for quality of life during adjuvant chemotherapy in gastric cancer: a randomized trial

Abstract Background Patients with locally advanced gastric cancer who undergo curative intent gastrectomy experience a decline in health-related quality of life (HRQOL) during adjuvant chemotherapy. The EAGER trial (Electro-Acupuncture in Gastric cancER) sought to evaluate the ability of electro-acupuncture (EA) to preserve HRQOL in these patients. Methods In this open-label, multi-center, parallel controlled trial, patients with stage II-III gastric cancer across 11 hospitals in China who were undergoing chemotherapy following gastrectomy were randomly assigned to receive high-frequency EA (HEA), low-frequency EA (LEA), or no EA during the first 3 cycles of chemotherapy. The Functional Assessment of Cancer Therapy-Gastric (FACT-Ga) was reported by patients at baseline and once weekly during the therapy. The primary outcome was the difference among groups in the FACT-Ga Trial Outcome Index (TOI) trajectory during the study duration by the standardized area under the curve (AUC). Results Of 222 patients randomized and analyzed, EA was associated with higher HRQOL measured by TOI-AUC [5678 ± 1229 (HEA), 5558 ± 1226 (LEA), and 4735 ± 1233 (control), P < .001]. No difference was seen based on acupuncture dosing (P = .557). Participants in the EA groups also achieved significantly improved disease-free survival (DFS) [HEA vs. Control, HR = 0.47 (0.24-0.93), P = .026; LEA vs. Control, HR = 0.51 (0.28-0.95), P = .030], fewer grade 3-4 adverse events (20.7% vs. 39.0%, P = .004), and decreased peripheral myeloid-derived suppressor cells (P = .038), compared with the control group. Conclusions Use of EA resulted in higher HRQOL in gastric cancer patients undergoing adjuvant chemotherapy, irrespective of dosing. EA was also associated with prolonged DFS and lower treatment-associated toxicities, which warrants further confirmative research. Trial registration ClinicalTrials.gov NCT04360577.