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Pharmacologic Therapies to Mitigate Radiation- Associated Heart Disease
Radiation therapy is an essential treatment for tumors in the chest area, including breast, lung, esophageal, mediastinal cancers, and spine metastases. Although technical advances have reduced treatment-related illness and death, radiation exposure to the heart can still cause substantial rates of radiation-induced heart disease (RIHD) among survivors.
For example, about 21% of non-small cell lung cancer patients receiving a mean heart dose of 20 Gy or higher experience major adverse cardiac events (MACE) within 2 years. In breast cancer patients, the risk of MACE increases by about 7% for each additional Gy of mean heart dose.
There is currently no established medication strategy to prevent or reduce RIHD.
Preclinical and clinical studies show that statins and angiotensin-converting enzyme (ACE) inhibitors may help reduce radiation-induced heart disease (RIHD). Statins and ACE inhibitors are generally well tolerated, available as generic drugs, and commonly used to help prevent cardiovascular disease. They may protect the heart by reducing damage to blood vessel lining (endothelial damage), microvascular dysfunction, atherosclerosis, reduced blood flow (ischemia), and fibrosis (scarring).
This study is a prospective, randomized, placebo-controlled phase II hybrid decentralized trial. Patients receiving standard radiation therapy and expected to receive an equivalent dose of at least 25 Gy (EQD2) to at least 10% of the heart will be randomly assigned to receive either:
- placebo, or
- Atorvastatin 20 mg plus Lisinopril 5 mg daily. The medications will be taken during radiation therapy and continued for 6 months after treatment.
The study aims to determine whether the intervention can reduce radiation-related decreases in blood flow to the heart, measured using myocardial perfusion imaging, such as positron emission tomography (PET), which is commonly used to evaluate the risk of coronary heart disease.
Studie Overzicht
Toestand
Conditie
Interventie / Behandeling
Studietype
Inschrijving (Geschat)
Fase
- Fase 2
Contacten en locaties
Studiecontact
- Naam: Claire Kowalczyk
- Telefoonnummer: 984-974-0000
- E-mail: claire_kowalczyk@med.unc.edu
Studie Locaties
-
-
North Carolina
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Chapel Hill, North Carolina, Verenigde Staten, 27599
- Werving
- Lineberger Comprehensive Cancer Center at University of North Carolina, Chapel Hill
-
Hoofdonderzoeker:
- Shivani Sud, MD
-
Contact:
- Claire Kowalczyk
- Telefoonnummer: 984-974-0000
- E-mail: claire_kowalczyk@med.unc.edu
-
-
Deelname Criteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
- Volwassen
- Oudere volwassene
Accepteert gezonde vrijwilligers
Beschrijving
Inclusion Criteria:
- Written informed consent obtained to participate in the study and HIPAA
- authorization for release of personal health information.
- Subjects is willing and able to comply with study procedures based on the
- judgement of the investigator.
- Consent for serial blood draws and consent for use of biological specimens.
- Age ≥ 18 years at the time of consent
Exclusion Criteria:
- Pregnant or breastfeeding (NOTE: breast milk cannot be stored for future use while the mother is being treated on study).
- Pre-existing use of a statin or ACE-inhibitor
- Pre-existing hypotension
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Ondersteunende zorg
- Toewijzing: Gerandomiseerd
- Interventioneel model: Parallelle opdracht
- Masker: Enkel
Wapens en interventies
Deelnemersgroep / Arm |
Interventie / Behandeling |
|---|---|
|
Experimenteel: statins and angiotensin-converting enzyme (ACE) inhibitors
Patients expected to receive ≥25 Gy equivalent dose in 2 Gy fractions (EQD2) to at least 10% of the heart will be treated with statins and angiotensin-converting enzyme (ACE) inhibitors.
|
Patients will receive statins and angiotensin-converting enzyme (ACE) inhibitors.
|
|
Placebo-vergelijker: Placebo
Patients expected to receive ≥25 Gy equivalent dose in 2 Gy fractions (EQD2) to at least 10% of the heart will take inhibitors.
|
Patiënten krijgen een placebo.
|
Wat meet het onderzoek?
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
|
Percent difference in the radiation (RT)-induced reduction of myocardial perfusion
Tijdsspanne: Pre radiation therapy and 6-month post radiation therapy
|
Percent difference in the radiation (RT)-induced reduction of myocardial perfusion in cardiac regions receiving ≥25Gy equivalent dose in 2Gy fractions (EQD2) based on comparison of before and after RT among participants receiving placebo and statins and angiotensin-converting enzyme (ACE) inhibitors intervention.
|
Pre radiation therapy and 6-month post radiation therapy
|
Secundaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
|
Percent Change in Radiation-Induced Myocardial Perfusion Reduction by Cardiac Dose: Placebo vs Statin and ACE Inhibitor Therapy
Tijdsspanne: Pre radiation therapy and 6-month post radiation therapy
|
Percent difference in radiation therapy (RT)-induced reduction of myocardial perfusion in cardiac regions receiving different radiation doses (10-20 Gy and 20-25 Gy equivalent dose in 2 Gy fractions, EQD2), based on comparison of pre-RT and 6-month post-RT myocardial perfusion imaging scans between participants receiving placebo versus statins and angiotensin-converting enzyme (ACE) inhibitors intervention.
|
Pre radiation therapy and 6-month post radiation therapy
|
|
Change in for cardiac biomarker panel
Tijdsspanne: Pre radiation therapy and 3 months and 6-month post radiation therapy
|
Change in for cardiac biomarker panel including high- sensitivity troponin, Creatine Kinase myocardial band (CK-MB) or N-terminal pro-B-type Natriuretic Peptide( NT-proBNP).
|
Pre radiation therapy and 3 months and 6-month post radiation therapy
|
|
Correlation between cardiac stress and perfusion biomarkers and radiation dose
Tijdsspanne: Pre radiation therapy and 3 months and 6-month post radiation therapy
|
Correlations between absolute values and changes in cardiac stress/perfusion biomarkers and radiation dose at the individual pixel level will be compared between the placebo and intervention groups.
Cardiac perfusion imaging provides quantitative assessment of regional myocardial perfusion, and the absolute difference in RT-induced perfusion reduction between study arms will be evaluated using pre- and post-RT measurements.
Changes in cardiac biomarkers, including high- sensitivity troponin, Creatine Kinase myocardial band (CK-MB) or N-terminal pro-B-type Natriuretic Peptide( NT-proBNP).
will also be assessed.
|
Pre radiation therapy and 3 months and 6-month post radiation therapy
|
|
Rates of major adverse cardiac events
Tijdsspanne: At follow-up of 1, 2, and 3 years.
|
Rates of major adverse cardiac events (unstable angina, heart failure hospitalization or urgent visit, myocardial infarction, coronary revascularization, and cardiac death) will be compared between trial groups at long-term
|
At follow-up of 1, 2, and 3 years.
|
Medewerkers en onderzoekers
Onderzoekers
- Hoofdonderzoeker: Shivani Sud, MD, UNC Lineberger Comprehensive Cancer Center
Publicaties en nuttige links
Studie record data
Bestudeer belangrijke data
Studie start (Werkelijk)
Primaire voltooiing (Geschat)
Studie voltooiing (Geschat)
Studieregistratiedata
Eerst ingediend
Eerst ingediend dat voldeed aan de QC-criteria
Eerst geplaatst (Werkelijk)
Updates van studierecords
Laatste update geplaatst (Werkelijk)
Laatste update ingediend die voldeed aan QC-criteria
Laatst geverifieerd
Meer informatie
Termen gerelateerd aan deze studie
Trefwoorden
Aanvullende relevante MeSH-voorwaarden
- Ziekten van het centrale zenuwstelsel
- Ziekten van het zenuwstelsel
- Neoplasmata per site
- Neoplasmata
- Ziekten van de luchtwegen
- Gastro-intestinale neoplasmata
- Neoplasmata van het spijsverteringsstelsel
- Ziekten van het spijsverteringsstelsel
- Gastro-intestinale aandoeningen
- Longziekten
- Hoofd- en nekneoplasmata
- Neoplasmata van de luchtwegen
- Slokdarmaandoeningen
- Huidziektes
- Borst ziekten
- Neoplasmata van het zenuwstelsel
- Neoplasmata van het centrale zenuwstelsel
- Ziekten van het ruggenmerg
- Mediastinale ziekten
- Thoracale ziekten
- Huid- en bindweefselaandoeningen
- Longneoplasmata
- Hart-en vaatziekten
- Slokdarmneoplasmata
- Borstneoplasmata
- Thoracale neoplasmata
- Neoplasmata van het ruggenmerg
- Mediastinale neoplasmata
- Peptiden
- Aminozuren, peptiden en eiwitten
- Oligopeptiden
- Heterocyclische verbindingen, 1-ring
- Heterocyclische verbindingen
- Vetzuren
- Lipiden
- Azoles
- Pyrroles
- Heptaanzuren
- Dipeptiden
- Atorvastatine
- Lisinopril
Andere studie-ID-nummers
- LCCC2239-DCT
Plan Individuele Deelnemersgegevens (IPD)
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