ANTEC: Atherosclerosis in Chemotherapy-related Cardiotoxicity
Study Details
Study Description
Brief Summary
Cardiological complications of oncological treatment, including the most serious of them cardiotoxicity and heart failure, constitute a significant and still unsolved clinical problem. A history of hypercholesterolaemia and coronary artery disease in cancer patients, is one of the risk factors for cardiotoxicity. In recent years, a protective effect of statin treatment on the development of heart failure in cancer patients has been observed. ANTEC (Atherosclerosis iN chemoTherapy-rElated Cardiotoxicity) is a prospective observational study aimed at assessing the impact of the advancement of atherosclerotic lesions in the coronary arteries assessed in computed tomography on the development of left ventricular systolic dysfunction in cancer patients at high risk of myocardial damage. A group of 80 patients diagnosed with cancer before starting high-dose anthracycline chemotherapy (doxorubicin ≥ 240 mg / m2 or epirubicin ≥ 540 mg / m2 body weight), without a history of heart failure and coronary artery disease, will be included in the study. The total follow-up of patients was planned for 12 months. The primary endpoint is time to onset of left ventricular systolic dysfunction as assessed by echocardiography. The secondary composite endpoints include all-cause death, cardiovascular death, myocardial infarction, and stroke. Additionally, the assessment will include: the severity of atherosclerotic changes in the coronary arteries and the calcification index in computed tomography, the percentage decrease in left ventricular ejection fraction, GLS (global longitudinal strain) and MWI (myocardial work index) in echocardiography, and changes in the concentration of biomarkers involved in inflammatory and atherosclerotic processes. This is the first study of this type, which we hope will contribute to a better understanding of the pathophysiology of cardiotoxicity development and to changing the standards of management of oncological patients and improving survival in this group of patients.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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Detailed Description
Cardiological complications of oncological treatment, including the most serious:
cardiotoxicity and heart failure, remains the most dangerous cardiological complication of oncological treatment and are still unsolved clinical problem. The fear of the toxic effects of anti-cancer drugs may lead to the modification or abandonment of oncological treatment, and consequently shorten the survival time of cancer patients.
A history of hypercholesterolaemia and coronary artery disease in cancer patients, is one of the risk factors for cardiotoxicity. In recent years, a protective effect of statin treatment on the development of heart failure in cancer patients has been observed. ANTEC (Atherosclerosis iN chemoTherapy-rElated Cardiotoxicity) is a prospective observational study aimed at assessing the impact of the advancement of atherosclerotic lesions in the coronary arteries assessed in computed tomography on the development of left ventricular systolic dysfunction in cancer patients at high risk of myocardial damage. A group of 80 patients diagnosed with cancer before starting high-dose anthracycline chemotherapy (doxorubicin ≥ 240 mg / m2 or epirubicin ≥ 540 mg / m2 body weight), without a history of heart failure and coronary artery disease, will be included in the study. The total follow-up of patients was planned for 12 months. The primary endpoint is time to onset of left ventricular systolic dysfunction as assessed by echocardiography. The secondary composite endpoints include all-cause death, cardiovascular death, myocardial infarction, and stroke. Additionally, the assessment will include: the severity of atherosclerotic changes in the coronary arteries and the calcification index in computed tomography, the percentage decrease in left ventricular ejection fraction, GLS (global longitudinal strain) and MWI (myocardial work index) in echocardiography, and changes in the concentration of biomarkers involved in inflammatory and atherosclerotic processes. This is the first study of this type, which we hope will contribute to a better understanding of the pathophysiology of cardiotoxicity development and to changing the standards of management of oncological patients and improving survival in this group of patients.
Study Design
Outcome Measures
Primary Outcome Measures
- Patients with left ventricular systolic dysfunction [from date of randomization until the end of study, up to 12 months]
echocardiography
Secondary Outcome Measures
- Time to the secondary composite endpoint: all-cause death, cardiovascular death, myocardial infarction, and stroke [from date of randomization until the end of study, up to 12 months]
medical records
Other Outcome Measures
- The presence of atherosclerosis in the coronary arteries and the calcification index [from date of randomization until the end of study, up to 12 months]
computed tomography
- Percentage decrease in left ventricular ejection fraction, GLS (global longitudinal strain) and MWI (myocardial work index) [from date of randomization until the end of study, up to 12 months]
echocardiography
- Changes in the concentration of biomarkers involved in inflammatory and proatherosclerotic processes (IL-6, MPO i TNF-alfa). [from date of randomization until the end of study, up to 12 months]
blood samples
Eligibility Criteria
Criteria
Inclusion Criteria:
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Eastern Cooperative Oncology Group (ECOG) performance status from 0 to 2.
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Age ≥18 years at the time of signing the informed consent.
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Known neoplastic disease prior to the initiation of chemotherapy with a high dose of anthracyclines (doxorubicin ≥ 240 mg / m2 b.w. or epirubicin ≥ 540 mg / m2 b.w.)
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No history of heart failure (left ventricular ejection fraction ≥ 50% as assessed by echocardiography).
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Missing history of: coronary artery disease, stroke and lower limb atherosclerosis
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Presence of at least two of the above-mentioned risk factors for the development of atherosclerosis (hypertension, diabetes, dyslipidemia, obesity (BMI≥30), smoking)
Exclusion Criteria:
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History of heart failure
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Left ventricle systolic dysfunction with LVEF <50%
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Significant valve defect
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Previous chemotherapy or radiation to the chest
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Presence of any disease with a life expectancy <1 year in the opinion of the investigator.
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Drug or alcohol abuse
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Lack of possibility or contraindications for coronary tomography before starting chemotherapy
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | National Institute of Oncology | Warsaw | Poland |
Sponsors and Collaborators
- Maria Sklodowska-Curie National Research Institute of Oncology
- Polish Cardiac Society
- Servier
Investigators
None specified.Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 80/2021