- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02471053
Exercise to Prevent AnthrCycline-based Cardio-Toxicity Study (EXACT)
Exercise to Prevent AnthrCycline-based Cardio-Toxicity Study (EXACT)
As the numbers of cancer survivors grow, the long-term adverse effects of cancer therapy are becoming increasingly apparent. Most prominent are the toxic effects on the heart (cardiotoxicity) which may lead to cardiac dysfunction and increased risk of cardiovascular disease (CVD). The investigators hypothesize that an individualized aerobic training program for cancer patients receiving active treatment will be both feasible and safe and will result in improvements in overall levels of physical activity and quality of life.
Feasibility will be assessed by evaluating the recruitment, adherence and attrition rates, along with program safety. Efficacy will be assessed by evaluating changes in health-related outcomes.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
As the numbers of cancer survivors grow, the long-term adverse effects of cancer therapy are becoming increasingly apparent. Most prominent are the toxic effects on the heart (cardiotoxicity) which may lead to cardiac dysfunction and increased risk of cardiovascular disease (CVD). Of note, data indicate that the magnitude of CVD risk for long-term survivors may exceed the risk of a secondary malignancy, which is a known complication of primary cancer therapy. While long-term follow-up data in adult cancer survivors is lacking, study of adult survivors of childhood cancers shows that these individuals are 15 times more likely to develop congestive heart failure (CHF), 10 times more likely to develop CVD, and 9 times more likely to suffer a stroke compared individuals who have not had cancer. Thus, it is clear that the long-term cardiotoxic effects of cancer therapy represent a significant concern for cancer survivors. The mechanisms responsible for the damaging effects of cancer therapy are not fully understood, however there is a need to maximize the benefits of treatment while minimizing long-term damage. Recent animal studies suggest that aerobic exercise training may offer a protective effect against chemotherapy-induced heart disease. However, to the investigator's knowledge, no study to date has examined the potential cardioprotective benefits of exercise training for patients receiving cancer treatment.
Accordingly, the purpose of this pilot study is to evaluate the feasibility and efficacy of a 12-week supervised exercise program based on the principles of cardiac rehabilitation for patients receiving anthracycline-based chemotherapy.
Feasibility will be assessed by evaluating three outcomes, recruitment rate, adherence rate (i.e. exercise class attendance records), attrition rate, and safety (i.e. number of adverse events).
Efficacy will be assessed by evaluating changes in health-related outcomes to assess if these changes are equal to or better than what was measured at baseline. The health-related outcomes include cardiac function and biological markers of cardiotoxicity.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Nova Scotia
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Halifax, Nova Scotia, Canada, B3H 3A7
- QEII Health Science Center, Nova Scotia Health Authority
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria - Only those patients who meet the following inclusion will be asked to participate in the study:
- Between the ages of 18 and 65;
- Receiving anthracycline chemotherapeutic treatment for a primary/non-recurrent breast or hematological malignancy;
- Are scheduled to received a minimum dose of 100 mg/m2 of doxorubicin (DOX) or 120 mg/m2 of daunorubicin (DAUN), or 150 mg/m2 epirubicin (EPI)
- Within eight weeks of first anthracycline dose;
- Do not have a previous history of myocardial infarction, cerebrovascular disease, peripheral vascular disease, congestive heart failure, or cardiomyopathy (controlled hypertension is not exclusionary);
- Have no known contraindications to light-to-moderate exercise;
- Have no known contraindications to cardiopulmonary exercise stress testing;
- Able to participate in the 12-week community-based exercise program;
- Provided medical consent from their treating physician
Exclusion Criteria:
- Any patients who meet the inclusion criteria, but have any significant cognitive limitations will be excluded from the study.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Moderate Intensity Exercise
All consenting patients will participate in an aerobic training program, twice-weekly over a 12-week period.
Assessments will be performed at baseline (pre-training) and post-program (12-weeks).
All participants will continue to receive standard care for their cancer diagnosis.
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Exercise sessions will be held twice-weekly and will begin with a group warm-up activity, followed by 45 minutes of aerobic activity and ending with a cool down.
All aerobic exercise will be performed at a moderate intensity, defined as exercise that elicits a heart rate (HR) between 40-60% of heart rate reserve (HRR).
Prior to the initial exercise session target heart rates will be calculated for each subject based on the maximum HR achieved during their baseline stress test.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Feasibility as measured by rate of recruitment
Time Frame: 12 Weeks
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The rate of recruitment will be measured by comparing the number of patients screened to the number of patients enrolled (patients per month).
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12 Weeks
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Number of adverse events
Time Frame: 12 Weeks
|
The number of adverse events associated with exercise program will be used to examine safety.
|
12 Weeks
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Feasibility as measured by program adherence
Time Frame: 12 Weeks
|
The program adherence will be calculated by dividing the total number of exercise sessions by the number of actual session attended.
|
12 Weeks
|
Feasibility as measured by attrition rate
Time Frame: 12 Weeks
|
The attrition rate will be measured by the number of patients who drop out of the study.
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12 Weeks
|
Cardiac Function
Time Frame: 12 Weeks
|
Cardiac function will be measured by examining heart chamber size, ventricular function and blood flow between the cardiac chambers using a Multigated acquisition (MUGA) scan.
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12 Weeks
|
Cardiac Disease Risk
Time Frame: 12 Weeks
|
Cardiac disease risk will be measured using the Framingham Risk Score.
|
12 Weeks
|
Aerobic Fitness
Time Frame: 12 Weeks
|
Aerobic fitness will be measured by comparing baseline and 12 week cardiac stress tests and the associated peak oxygen uptake values.
|
12 Weeks
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Fatigue
Time Frame: 12 Weeks
|
The Functional Assessment of Cancer Therapy - Fatigue questionnaire will be used to compare baseline and 12 week self-reported levels of fatigue.
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12 Weeks
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Physical Activity Behaviours
Time Frame: 12 Weeks
|
Baseline and 12 week levels of physical activity will be measured using the International Physical Activity Questionnaire.
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12 Weeks
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Life Quality
Time Frame: 12 Weeks
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The Functional Assessment of Cancer Therapy - General questionnaire along with the appropriate tumor specific appendix, will be used to compare baseline and 12 week quality of life measures.
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12 Weeks
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Lipid Profile
Time Frame: 12 Weeks
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Baseline and 12 week levels will be compared.
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12 Weeks
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Fasting Glucose
Time Frame: 12 Weeks
|
Baseline and 12 week levels will be compared.
|
12 Weeks
|
High-sensitivity Troponin (hs-TNT)
Time Frame: 12 Weeks
|
Baseline and 12 week levels will be compared.
|
12 Weeks
|
N-terminal of the prohormone brain natriuretic peptide (NTproBNP)
Time Frame: 12 Weeks
|
Baseline and 12 week levels will be compared.
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12 Weeks
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C-reactive protein (CRP)
Time Frame: 12 Weeks
|
Baseline and 12 week levels will be compared.
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12 Weeks
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Cytokines (IL-1α)
Time Frame: 12 Weeks
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Baseline and 12 week levels (picogram per milileter) will be compared.
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12 Weeks
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Cytokines (IL-1β)
Time Frame: 12 Weeks
|
Baseline and 12 week levels (picogram per milileter) will be compared.
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12 Weeks
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Cytokines (IL-4)
Time Frame: 12 Weeks
|
Baseline and 12 week levels (picogram per milileter) will be compared.
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12 Weeks
|
Cytokines (IL-6)
Time Frame: 12 Weeks
|
Baseline and 12 week levels (picogram per milileter) will be compared.
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12 Weeks
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Cytokines (IL-10)
Time Frame: 12 Weeks
|
Baseline and 12 week levels (picogram per milileter) will be compared.
|
12 Weeks
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Cytokines (IL-17)
Time Frame: 12 Weeks
|
Baseline and 12 week levels (picogram per milileter) will be compared.
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12 Weeks
|
Cytokines (TNFα)
Time Frame: 12 Weeks
|
Baseline and 12 week levels (picogram per milileter) will be compared.
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12 Weeks
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Scott Grandy, PhD, Assistant Professor, Affiliate Scientist, Division of Cardiology, Nova Scotia Health Authority
Publications and helpful links
General Publications
- Albini A, Pennesi G, Donatelli F, Cammarota R, De Flora S, Noonan DM. Cardiotoxicity of anticancer drugs: the need for cardio-oncology and cardio-oncological prevention. J Natl Cancer Inst. 2010 Jan 6;102(1):14-25. doi: 10.1093/jnci/djp440. Epub 2009 Dec 10.
- Yeh ET. Cardiotoxicity induced by chemotherapy and antibody therapy. Annu Rev Med. 2006;57:485-98. doi: 10.1146/annurev.med.57.121304.131240.
- Oeffinger KC, Mertens AC, Sklar CA, Kawashima T, Hudson MM, Meadows AT, Friedman DL, Marina N, Hobbie W, Kadan-Lottick NS, Schwartz CL, Leisenring W, Robison LL; Childhood Cancer Survivor Study. Chronic health conditions in adult survivors of childhood cancer. N Engl J Med. 2006 Oct 12;355(15):1572-82. doi: 10.1056/NEJMsa060185.
- Keats MR, Grandy SA, Giacomantonio N, MacDonald D, Rajda M, Younis T. EXercise to prevent AnthrCycline-based Cardio-Toxicity (EXACT) in individuals with breast or hematological cancers: a feasibility study protocol. Pilot Feasibility Stud. 2016 Aug 5;2:44. doi: 10.1186/s40814-016-0084-9. eCollection 2016.
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- EXACT2015
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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