Cancer Clinical Trial
Randomized Double Blind Placebo Controlled Trial of Statins for the Primary pREvention of Heart Failure in Patients With Cancer Receiving Anthracycline Based Chemotherapy
|Source||University Health Network, Toronto|
|Status||Not yet recruiting|
|Start date||July 2017|
|Completion date||January 2020|
Anthracycline (AC) chemotherapy has substantially reduced the mortality rate from several
common cancers globally. Unfortunately, AC treatment is associated with up to 19% risk of
heart failure (HF). Current standard of care for preventing AC induced HF (AIHF) is cardiac
surveillance followed by initiation of treatment once HF is diagnosed. With this approach
89% of patients fail to recover heart function and 46% will experience adverse cardiac
events. Therefore there is a need for effective preventive therapy to reduce the risk of
AIHF. Based on small human studies, animal studies, and our own pilot data, statins are an
ideal class of drug for this purpose.
We will conduct a pilot double blinded, placebo controlled, randomized controlled trial to assess whether pre-treatment with statins before AC can prevent heart dysfunction. Eligible patients with cardiovascular risk factors scheduled to receive AC will be recruited. They will be randomized to statin therapy or placebo and followed until the end of cancer treatment. Primary outcome is the difference in cardiac MRI-determined left ventricular ejection fraction between pre-AC and end of treatment.
STUDY DESIGN: This is a double blind, placebo controlled randomized controlled trial (RCT).
We will also use stratification to ensure that the proportion of patients with different
malignancies is balanced between the study arms.
PATIENT RECRUITMENT: Patients will be recruited from respective oncology clinics at Princess Margaret Hospital, Mount Sinai Hospital, St. Michael's Hospital, Sunnybrook Health Sciences Centre and Scarborough General Hospital.
INTERVENTION: Patients will receive treatment with 40mg/day of atorvastatin or placebo started 2-10 days prior to the initiation of AC and continued for one month after completion of cancer treatment.
CARDIAC MRI (CMR): Studies will be performed on a 3.0T scanner (Siemens) and will include complete function and tissue characterization. CMR studies will be performed pre-therapy and after completion of AC. After de-identification and randomization, a research assistant blinded to all clinical data will perform all CMR analysis using commercially available software.
ECHOCARDIOGRAPHY: Routine echocardiography studies will be performed at the time of Cardiac MRI.
SERUM BIOMARKERS: Blood work will be obtained on the day of baseline imaging, immediately after each cycle of anthracycline, and on the day of post treatment imaging . At each time point samples of bio-banking will be collected. Blood sample collection will be done locally at the participant's respective site and transferred to University Health Network (UHN) biobank for future analysis or analysis of markers that are not available at all sites (e.g. high sensitivity troponin I and BNP).
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