- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03879629
TrAstuzumab Cardiomyopathy Therapeutic Intervention With Carvedilol (TACTIC)
TrAstuzumab Cardiomyopathy Therapeutic Intervention With Carvedilol (TACTIC) Trial
Study Overview
Detailed Description
The objective of the current application is to evaluate different strategies of cardiovascular therapy with carvedilol, aiming to reduce the incidence of LVEF decline and HF in patients undergoing curative intent trastuzumab-based HER2-directed therapy for breast cancer. It will compare: a) a pre-emptive preventive approach, i.e. cardiovascular therapy with the beta-blocker carvedilol started before trastuzumab-based HER2-directed therapy and b) a reactive preventive approach, i.e. cardiovascular therapy started in response to early subclinical signs of cardiac dysfunction/injury (either cardiac troponin elevation or abnormal global longitudinal strain), with the current standard approach of initiation cardiovascular therapy once cardiotoxicity has occurred, addressing the question if and at which point in time carvedilol therapy would be efficacious. It will furthermore compare outcome measures between a limited carvedilol therapy duration, confined to the time of the active trastuzumab-based HER2-directed treatment and cardiac function recovery versus an extended carvedilol therapy duration continuing one year after completion of trastuzumab-based HER2-directed therapy, addressing how long carvedilol needs to be given in this unique patient population. The above will be combined with pharmacogenomic measures to identify those at highest risk of irreversible LVEF decline and lack of response to therapy. The investigator's central hypothesis is that a pre-emptive or a reactive preventive approach will reduce the incidence of cardiotoxicity in breast cancer patients undergoing treatment with trastuzumab, and that extension of carvedilol therapy beyond the active trastuzumab-based HER2-directed therapy treatment will prove superior for preservation of cardiac function.
Three specific aims will be pursued:
Aim 1: to compare the incidence of a) HF or asymptomatic decline in LVEF by >10% in patients whose LVEF is ≥50% or LVEF drop ≥5% in those with a decrease to <50%. (primary aim #1), and b) reversible LVEF decline to within 5% of baseline (secondary aim #1) with a pre-emptive and reactive preventive approach with carvedilol versus a "wait-and-see strategy" of carvedilol initiation in response to HF or LVEF declines in breast cancer patients over the course of trastuzumab therapy. It is to address the question if and when to start cardioprotective efforts for patients undergoing trastuzumab therapy.
Aim 2: To compare the delta change in LVEF from completion to one year after completion of trastuzumab therapy between cardioprotective approach with carvedilol confined the duration of trastuzumab therapy or extended for one year thereafter. This aim is to address the question of duration of cardioprotective efforts for patients undergoing trastuzumab therapy.
Aim 3: To identify genetic variants that predict trastuzumab cardiotoxicity in general as well as lack of response (primary prevention of drop in LVEF or secondary improvement of LVEF) to carvedilol.
Study Type
Enrollment (Estimated)
Phase
- Phase 2
Contacts and Locations
Study Contact
- Name: Justin Gundelach
- Phone Number: 507-284-5467
- Email: gundelach.justin@mayo.edu
Study Locations
-
-
Arizona
-
Phoenix, Arizona, United States, 85054
- Active, not recruiting
- Mayo Clinic
-
-
Florida
-
Jacksonville, Florida, United States, 32224
- Recruiting
- Mayo Clinic in Florida
-
Contact:
- Clinical Trials Referral Office
- Phone Number: 855-776-0015
- Email: mayocliniccancerstudies@mayo.edu
-
-
Minnesota
-
Rochester, Minnesota, United States, 55905
- Recruiting
- Mayo Clinic in Rochester
-
Principal Investigator:
- Joerg Herrmann, MD
-
Principal Investigator:
- Katherine Ruddy, MD
-
Contact:
- Clinical Trials Referral Office
- Phone Number: 855-776-0015
- Email: mayocliniccancerstudies@mayo.edu
-
-
Missouri
-
Saint Louis, Missouri, United States, 63110
- Recruiting
- Washington University in St. Louis
-
Contact:
- Joshua Mitchell, M.D.
- Phone Number: 314-273-1698
- Email: jdmitchell@wustl.edu
-
Principal Investigator:
- Joshua Mitchell, M.D.
-
-
Texas
-
Houston, Texas, United States, 77030
- Recruiting
- MD Anderson Cancer Center
-
Contact:
- Anita Deswal, M.D.
- Phone Number: 832-792-1895
- Email: adeswal@mdanderson.org
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Principal Investigator:
- Anita Deswal, M.D.
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- ≥18 years of age,
- new or locally recurrent diagnosis of HER2+ breast cancer that will be treated with curative intent
- planned HER2-directed (any therapy targeting HER2 signaling including Trastuzumab +/- pertuzumab or trastuzumab-emtansine (T-DM1) Nerantinib and lapatinib will not be considered. "HER2-directed therapy" or "anti-HER-2".
Exclusion Criteria:
- history of HF of any class and type, or diagnosis of cardiomyopathy in the past,
- LVEF <50% at screening,
- intolerance to beta-blocker,
- baseline use of any beta-blocker for coronary artery disease including myocardial infarction
- current ACE inhibitor or ARB therapy for hypertension in the presence of diabetes and/or for chronic kidney disease/proteinuria,
- on active therapy with amiodarone, sotalol, or any other antiarrhythmic
- Diagnosis of asthma with current daily use of anti-asthmatic therapy
- heart rate < 50 BPM at screening (average of 3 most recent readings)
- history of or current sick sinus syndrome,
- AV block grade II or higher (unless patient has a permanent pacemaker) at screening,
- systolic blood pressure < 90 mmHg at screening (average of 3 most recent readings)
- severe hepatic dysfunction, as defined by NCI ODWG (total bilirubin >3x ULN, any AST elevation) or Child Pugh C class
- pregnancy
- Metastatic breast cancer (distant metastases)
- Active systemic treatment for non-breast cancer
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Supportive Care
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Pre-Emptive Strategy
Carvedilol titrated to maximally tolerated doses (3.125 mg to 25 mg twice a day) initiated one week before start of therapy and continued until end of therapy
|
oral Carvedilol maximally tolerated doses 3.125 mg to 25 mg twice a day
Other Names:
|
Experimental: Reactive Strategy
Carvedilol titrated to maximally tolerated doses (3.125 mg to 25 mg twice a day) initiated after documentation of subclinical cardiotoxicity, defined by an abnormal global longitudinal strain (GLS) or high-sensitive cardiac troponin (hsTnI) elevation and continued until end of therapy
|
oral Carvedilol maximally tolerated doses 3.125 mg to 25 mg twice a day
Other Names:
|
Active Comparator: Standard of Care
Carvedilol titrated to maximally tolerated doses (3.125 mg to 25 mg twice a day) initiated after documentation of a drop in LVEF by >10% to a value less than 53% and continued until end of therapy
|
oral Carvedilol maximally tolerated doses 3.125 mg to 25 mg twice a day
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Rate of asymptomatic and symptomatic cardiac dysfunction
Time Frame: 1 year
|
Incidence of heart failure or asymptomatic decline in left-ventricular ejection fraction (LVEF) by >10% in patients whose LVEF is ≥50% or LVEF drop ≥5% in those with a decrease to <50% (primary outcome measure)
|
1 year
|
Rate of reversible cardiac function decline
Time Frame: 1 year
|
Reversible LVEF decline to within 5% of baseline (secondary primary outcome measure)
|
1 year
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Cardiac function changes after completion of HER2-directed therapy
Time Frame: 1 year
|
Delta change in LVEF from completion to one year after completion of trastuzumab-based HER2-directed therapy
|
1 year
|
Gene variants and risk of cardiotoxicity and response to therapy
Time Frame: 2 years
|
Correlation of absolute delta change in GLS and LVEF while on trastuzumab and after stopping trastuzumab with the frequency of the following SNPs: trastuzumab-related: p<1x10-5 hits from Norton GWAS (six loci) 130 HER 2 Ile665Val, HER2 Pro1170Ala125, 126, 130, anthracycline-related: ABCB1 rs1128503, ABCB4 rs1149222, ABCC1 rs45511401, ABCC2 res17222723, CAT rs10836235, CBR3 rs1056892, CYBA rs4673, CYP3A4*22 rs35599367, NCF4 rs1883112, RAC2 rs13058338, RARG rs2229774, SLC28A3 rs7853758, TOP2B rs10865801, and UGT 1A6*4 rs1786378374, 150-152, beta-blocker-related: β2-AR Gln27Gln, β1-AR Arg389Arg 80-82 and CYP2D6 polymorphisms (CYP2D6 alleles (*1, *2, *3, *4, *5, *6, *7, *8, *9, *10, *11, *15, *17, *19, *20, *29, *35, *36, *40 and *41), as well as 7 CYP2D6 gene duplications (*1 9 N, *2 9 N, *4 9 N, *10 9 N, *17 9 N, *35 9 N and *41 9 N) by use of the AmpliChip CYP450 GeneChip
|
2 years
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Joerg Herrmann, Mayo Clinic
Publications and helpful links
Helpful Links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Heart Diseases
- Cardiovascular Diseases
- Cardiomyopathies
- Physiological Effects of Drugs
- Adrenergic beta-Antagonists
- Adrenergic Antagonists
- Adrenergic Agents
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Antihypertensive Agents
- Vasodilator Agents
- Protective Agents
- Membrane Transport Modulators
- Calcium-Regulating Hormones and Agents
- Calcium Channel Blockers
- Antioxidants
- Adrenergic alpha-1 Receptor Antagonists
- Adrenergic alpha-Antagonists
- Carvedilol
Other Study ID Numbers
- MC1932
- R01CA233610 (U.S. NIH Grant/Contract)
- NCI-2019-08427 (Other Grant/Funding Number: NCI)
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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