Cardioprotective Effect of Empagliflozin in Breast Cancer Patients
Effects of Empagliflozin Versus Metformin in Women With Breast Cancer Receiving Doxorubicin-Based Chemotherapy: A Prospective Randomized Controlled Cardio-Oncology Trial
Background: Doxorubicin (DOX) remains a cornerstone in adjuvant and neoadjuvant therapy for breast cancer, but its utility is hindered by dose-dependent cardiotoxicity. Both SGLT2 inhibitors (Empagliflozin) and Biguanides (Metformin) have demonstrated off-target cardioprotective and metabolic properties in preclinical and clinical settings.
Objective: To compare the cardioprotective efficacy, safety, and metabolic/oncologic outcomes of Empagliflozin versus Metformin in non-diabetic or controlled-diabetic women with breast cancer undergoing doxorubicin-based chemotherapy.
Design: Prospective, 3-arm, open-label (or double-blind), randomized controlled clinical trial (RCT).
Duration: 18 months
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Detaljeret beskrivelse
Background & Rationale Anthracyclines, primarily Doxorubicin, induce cardiotoxicity through reactive oxygen species (ROS) accumulation, topoisomerase II-beta inhibition, mitochondrial dysfunction, and cardiomyocyte apoptosis.
- Empagliflozin (SGLT2 inhibitor): Reduces oxidative stress, attenuates cardiac inflammation, improves myocardial energy bioenergetics, and prevents adverse left ventricular remodeling independently of glycemic status.
- Metformin (AMPK activator): Restores autophagic flux, preserves mitochondrial membrane potential, reduces ROS production, and exhibits anti-tumor proliferation effects.
Gaps in Knowledge: While both drugs individually show promise against anthracycline-induced cardiotoxicity (AIC), direct head-to-head clinical trials comparing an SGLT2i versus Metformin during active anthracycline treatment are lacking.
3. Study Hypothesis
- Primary Hypothesis: Prophylactic administration of Empagliflozin or Metformin significantly attenuates the subclinical decline in Left Ventricular Ejection Fraction (LVEF) and Global Longitudinal Strain (GLS) compared to standard care in women receiving doxorubicin.
Secondary Hypothesis: Empagliflozin demonstrates superior reduction in cardiac biomarker elevation (hs-cTnI, NT-proBNP) and microvascular strain compared to Metformin.
4. Study Objectives Primary Objective To compare the changes in left ventricular systolic function (measured via baseline to 6-month Echocardiographic GLS and LVEF) among the Empagliflozin group, Metformin group, and Control group.
Secondary Objectives
- Evaluate subclinical myocardial injury via serum biomarkers: High-sensitivity Cardiac Troponin I (hs-cTnI) and N-terminal pro-B-type Natriuretic Peptide (NT-proBNP).
- Monitor metabolic profiles (fasting blood glucose, HbA1c, and lipid profile).
- Evaluate patient-reported outcomes (Karnofsky Performance Scale / Minnesota Living with Heart Failure Questionnaire).
- Compare the safety profile, chemotherapy completion rates, and short-term oncologic response (pathological Complete Response in neoadjuvant settings).
Methodology & Study Design 5.1 Study Settings and Design
- Design: Prospective, randomized, parallel-group, active-controlled trial.
- Setting: Tanta Oncology Hospital / Cardio-Oncology Center. 5.2 Participant Eligibility Criteria
Inclusion Criteria:
- Adult females (≥18 years) with histologically confirmed breast cancer.
- Scheduled to receive doxorubicin-based chemotherapy regimens (e.g., AC regimen: Doxorubicin + Cyclophosphamide every 2 or 3 weeks for 4 cycles).
- Baseline LVEF ≥ 55 on transthoracic echocardiography with normal baseline GLS.
- Estimated Glomerular Filtration Rate (eGFR) < 45 mL/min/1.73 m2
- Written informed consent provided.
Exclusion Criteria:
- Prior exposure to anthracyclines, mediastinal radiation, or anti-HER2 therapy.
- Pre-existing heart failure, coronary artery disease, or LVEF $< 55\%$.
- Uncontrolled Type 2 Diabetes Mellitus (HbA1c $> 8.5\%$) or Type 1 Diabetes Mellitus.
- Severe renal impairmet (eGFR < 45 mL/min/1.73 m2) or hepatic dysfunction.
- History of recurrent Urinary Tract Infections (UTIs), genital mycotic infections, or ketoacidosis (for Empagliflozin safety).
- Hypersensitivity to Empagliflozin or Metformin.
Undersøgelsestype
Undersøgelsestype
Tilmelding (Anslået)
Tilmelding
Fase
Fase
- Fase 3
Kontakter og lokationer
Studiekontakt
Studiekontakt
- Navn: Mai Aboelyazed El-Gebaly, Associate Lecturer
- Telefonnummer: 020 +0201061412257
- E-mail: dr.mai.elgebaly@gmail.com
Undersøgelse Kontakt Backup
- Navn: Mai Aboelyazed Elgebaly, Associate Lecturer
- Telefonnummer: 020 +201115064114
- E-mail: dr.mai.elgebaly@gmail.com
Studiesteder
-
-
Elgharbeya
-
Tanta, Elgharbeya, Egypten, GHR
- Tanta University
-
Kontakt:
- Mai Aboelyazed El-Gebaly, Associate Lecturer
- Telefonnummer: 020 010-6141-2257
- E-mail: dr.mai.elgebaly@gmail.com
-
Kontakt:
- Mai Aboelyazed Elgebaly, Associate Lecturer
- Telefonnummer: 020 011-1506-4114
- E-mail: dr.mai.elgebaly@gmail.com
-
Underforsker:
- Mohamed Abdelhamid Alameldein, Professor
-
-
Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
- Voksen
- Ældre voksen
Tager imod sunde frivillige
Beskrivelse
Inclusion Criteria:
- Adult females (≥18 years) with histologically confirmed breast cancer.
- Scheduled to receive doxorubicin-based chemotherapy regimens (e.g., AC regimen: Doxorubicin + Cyclophosphamide every 2 or 3 weeks for 4 cycles).
- Baseline LVEF ≥ 55 on transthoracic echocardiography with normal baseline GLS.
- Estimated Glomerular Filtration Rate (eGFR) < 45 mL/min/1.73 m2
- Written informed consent provided
Exclusion Criteria:
- Prior exposure to anthracyclines, mediastinal radiation, or anti-HER2 therapy.
- Pre-existing heart failure, coronary artery disease, or LVEF $< 55\%$.
- Uncontrolled Type 2 Diabetes Mellitus (HbA1c $> 8.5\%$) or Type 1 Diabetes Mellitus.
- Severe renal impairmet (eGFR < 45 mL/min/1.73 m2) or hepatic dysfunction.
- History of recurrent Urinary Tract Infections (UTIs), genital mycotic infections, or ketoacidosis (for Empagliflozin safety).
- Hypersensitivity to Empagliflozin or Metformin.
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Forebyggelse
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Ingen (Åben etiket)
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
|---|---|
|
Ingen indgriben: Arm A (Control)
Standard oncologic care without cardioprotective intervention followed concurrently for 12 weeks
|
|
|
Aktiv komparator: Arm B (Empaglflozin)
Empagliflozin 10 mg orally once daily initiated 1 week prior to chemotherapy; continued for 12 weeks
|
Intervention group: A group in which patients receive Empagliflozin drug at a dose of 10 mg once in the day, or along with chemotherapy.
|
|
Aktiv komparator: Arm C (Metformin)
Metformin 500 mg orally twice daily (escalated to 1000 mg twice daily as tolerated) initiated 1 week prior to chemotherapy; continued for 12 weeks
|
Metformin 500 mg orally twice daily (escalated to 1000 mg twice daily as tolerated) Initiated 1 week prior to chemotherapy; continued for 12 weeks
|
Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
LVEF (Left ventricular ejection fraction) : The left ventricular drain fraction or the amount of blood pumped from the left ventricle with each contraction.
Tidsramme: 6 months
|
LVEF from baseline (T0) to 6-month follow-up (T3), measured by 2D Speckle-Tracking Echocardiography.
|
6 months
|
Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Efterforskere
Efterforskere
- Studieleder: Mohamed Abdelhamid Almeldein, Professor, Tanta University
- Studieleder: Mohamed Abdelhamid Alameldein, Professor, Tanta University
Publikationer og nyttige links
Datoer for undersøgelser
Studer store datoer
Studiestart (Anslået)
Studiestart
Primær færdiggørelse (Anslået)
Primær færdiggørelse
Studieafslutning (Anslået)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Yderligere relevante MeSH-vilkår
Andre undersøgelses-id-numre
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