Identifying Subgroups With High Cardiovascular Risk in Breast Cancer Survivors

Cardiovascular Diseases Clinical Trial

— HARBOR  

Official title:

HARBOR Study: Identifying Subgroups With High Cardiovascular Risk in Breast Cancer Survivors

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT02485626
• Other study ID #: NL49405.031.14
• Status: Recruiting
• Phase: N/A
• First received: June 23, 2015
• Last updated: October 28, 2016
• Start date: April 2015
• Est. completion date: December 2019

Study information

• Verified date: October 2016
• Source: The Netherlands Cancer Institute
• Contact: Flora E. van Leeuwen, Prof. dr.
• Email: f.v.leeuwen[@]nki.nl
• Is FDA regulated: No
• Health authority: Netherlands: Medical Ethics Review Committee (METC)Netherlands: The Central Committee on Research Involving Human Subjects (CCMO)
• Study type: Observational [Patient Registry]

Clinical Trial Summary

The purpose of this study is to evaluate the prevalence of (sub)clinical cardiovascular disease, cardiovascular risk factors and metabolic abnormalities among long-term breast cancer survivors treated with or without anthracyclines in order to identify patients at increased risk of developing cardiovascular disease.

Description:

Rationale: Breast cancer (BC) incidence is increasing, while mortality from BC is decreasing. Since the life expectancy of BC patients is improving, the evaluation of treatment-associated cardiovascular disease (CVD) in BC survivors is becoming increasingly important. An excess risk of CVD, mainly due to coronary heart disease (CHD), has been observed after radiotherapy (RT) as administered in the 1960s-1980s. Anthracycline-containing CT and trastuzumab are known to induce cardiotoxicity, especially congestive heart failure (CHF). However, the long-term risks of CVD after anthracycline-containing CT, trastuzumab, hormonal therapy (HT) and contemporary RT techniques have hardly been examined. Furthermore, the potential interaction of these treatment modalities has not been well addressed, and there is limited knowledge about the contribution of classic cardiovascular risk factors and the metabolic syndrome to risk and severity of treatment-associated CVD in BC survivors.

Objectives: • to evaluate the prevalence of (sub)clinical CVD, cardiovascular risk factors and metabolic abnormalities among BC survivors treated with and without anthracyclines in two groups at (a) 5 - 7 years and (b) 10 - 12 years after diagnosis;

• to prospectively evaluate changes in prevalence of (sub)clinical CVD, cardiovascular risk factors and metabolic abnormalities after two years in the same patients.

Secondary objectives are to evaluate the predictive role of newly developed markers for CVD and to evaluate the effects of other BC treatment modalities, psychosocial outcomes, endocrine function and menopausal status on the risk of developing (sub)clinical CVD.

Study design: multicenter (AVL and UMCG) cross-sectional cohort study with prospective monitoring of the same cohort.

Study population: female BC survivors treated with and without anthracyclines 5 - 7 and 10 - 12 years ago at the AVL or UMCG, aged 40-50 years at time of therapy.

Main study parameter: the difference in (sub)clinical cardiovascular damage between patients treated with and without anthracyclines, as measured by left ventricular function parameters.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 628
• Est. completion date: December 2019
• Est. primary completion date: April 2019
• Accepts healthy volunteers: No
• Gender: Female
• Age group: 40 Years to 50 Years

Eligibility

Inclusion Criteria:

• early invasive BC (TNM stage I - III);

• diagnosed and/or treated in the AVL or UMCG;

• treated 5 - 7 years or 10 - 12 years ago;

• aged 40-50 years at time of therapy;

• signed written informed consent.

Exclusion Criteria:

• history of RT or CT unrelated to BC;

• current treatment for BC recurrence or second malignancy (including contralateral BC) with the exception of non-melanoma skin cancer or curatively treated carcinoma in situ of the cervix;

• history of cardiac disease (CHF, acute coronary syndrome, coronary revascularization procedure, symptomatic valvular dysfunction, cardiomyopathy or congenital heart defect) before diagnosis and treatment for BC;

• mental disability or psychological condition potentially hampering compliance with the study protocol;

• insufficient understanding of the Dutch language.

Study Design

Observational Model: Cohort, Time Perspective: Cross-Sectional

Related Conditions & MeSH terms

• Breast Neoplasms
• Cardiovascular Diseases

Intervention

Procedure:
• 2D tissue doppler echocardiography

Locations

Country	Name	City	State
Netherlands	NKI-AVL	Amsterdam
Netherlands	UMCG	Groningen

Sponsors (2)

Lead Sponsor	Collaborator
The Netherlands Cancer Institute	University Medical Center Groningen

Country where clinical trial is conducted

Netherlands, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Prospective evaluation of changes in LVEF, diastolic cardiac function, cardiac deformation, biomarkers levels, intima media thickness and arterial stiffness after two years in the same patients.	To compare each outcome of the first and second assessment separately in 1) every patient and 2) between patients treated with and without anthracyclines.	up to 14 years after breast cancer diagnosis	No
Primary	Left ventricular ejection fraction	The main study parameter will be the difference in left ventricular ejection fraction between patients treated with and without anthracyclines.	up to 12 years after breast cancer diagnosis	No
Secondary	Diastolic cardiac function	To compare diastolic cardiac function as measured by tissue doppler echocardiography (E/e' and E/A ratio) in patients treated with and without anthracyclines.	up to 12 years after breast cancer diagnosis	No
Secondary	Cardiac deformation	To compare cardiac deformation as measured by speckle tracking imaging (global longitudial strain, radial strain and circumferential strain) in patients treated with and without anthracyclines.	up to 12 years after breast cancer diagnosis	No
Secondary	Biomarker assessment	To compare levels of several (candidate) cardiovascular biomarkers (NT-proBNP, hs-TnT, CRP) in patients treated with and without anthracyclines.	up to 12 years after breast cancer diagnosis	No
Secondary	Intima media thickness and arterial stiffness	To compare intima media thcikness and arterial stiffness as measured by vascular ultrasound in patients treated with and without anthracyclines.	up to 12 years after breast cancer diagnosis	No