Side Effects Involving the Heart in Women With Breast Cancer Receiving Doxorubicin and Trastuzumab (PACE in BC)

This study is ongoing, but not recruiting participants.
Sponsor:
Collaborator:
Information provided by (Responsible Party):
Douglas Brian Sawyer, Vanderbilt University
ClinicalTrials.gov Identifier:
NCT00875238
First received: April 2, 2009
Last updated: August 5, 2014
Last verified: August 2014
  Purpose

RATIONALE: Studying samples of blood and tissue in the laboratory from women receiving doxorubicin and trastuzumab for breast cancer may help doctors learn more about changes that occur in DNA and identify biomarkers for increased risk of cardiac effects.

PURPOSE: This clinical trial is studying side effects involving the heart in women with breast cancer receiving doxorubicin and trastuzumab.


Condition Intervention
Breast Cancer
Cardiac Toxicity
Cardiovascular Complications
Biological: trastuzumab
Drug: doxorubicin hydrochloride
Genetic: polymorphism analysis
Other: laboratory biomarker analysis
Other: questionnaire administration
Procedure: assessment of therapy complications
Procedure: magnetic resonance imaging

Study Type: Observational
Study Design: Observational Model: Cohort
Time Perspective: Prospective
Official Title: Predicting Adverse Cardiac Events in Breast Cancer Therapy (PACE in Breast Cancer)

Resource links provided by NLM:


Further study details as provided by Vanderbilt University:

Primary Outcome Measures:
  • Change in cardiac function by echocardiogram [ Time Frame: 5 years ] [ Designated as safety issue: No ]
    change in cardiac function as measured by serial echocardiograms


Secondary Outcome Measures:
  • Overall feasibility [ Time Frame: 3 years ] [ Designated as safety issue: No ]

Biospecimen Retention:   Samples With DNA

Serum, Plasma, Mononuclear Cells


Estimated Enrollment: 200
Study Start Date: June 2008
Estimated Primary Completion Date: January 2015 (Final data collection date for primary outcome measure)
  Hide Detailed Description

Detailed Description:

OBJECTIVES:

Primary

  • To determine if polymorphisms in genes (e.g., CYBA, RAC2, NCF4, MRP1, MRP2, GTSP and CBR3) in women with breast cancer treated with doxorubicin hydrochloride increase the relative risk of developing ≥ NCI grade 1 cardiotoxicity. (Primary study)
  • To determine whether pre-treatment levels of biomarkers (e.g., neuregulin, IGF-1, cardiotrophin-1, IL-6, VEGF, hepatocyte growth factor, and heparin binding EGF) in these patients, correlate with relative risk of developing ≥ NCI grade 1 cardiotoxicity to this regimen. (Primary study)
  • To determine whether decreased heart rate variability and increased plasma levels of norepinephrine at 3 weeks after completion of this regimen correlate with relative risk of developing ≥ NCI grade 1 cardiotoxicity in these patients. (Primary study)
  • To determine whether decrease in endothelial progenitor cell (EPC) number at 3 weeks after completion of this regimen can be detected, and if so whether decreased EPC number correlates with ≥ NCI grade 1 cardiotoxicity. (Primary study)
  • To determine whether baseline physical fitness level of these patients, assessed by a questionnaire and 6 minute walk distance, correlates with relative risk of developing ≥ NCI grade 1 cardiotoxicity to this regimen. (Primary study)
  • To determine whether activity level of these patients during treatment, assessed by questionnaire, correlates with relative risk of developing ≥ NCI grade 1 cardiotoxicity to this regimen. (Primary study)
  • To determine whether drop in functional capacity of these patients, measured by 6 minute walk distance at the end of treatment with this regimen, correlates with ≥ NCI grade 1 cardiotoxicity. (Primary study)
  • To determine whether MRI can detect changes in diastolic heart function in these patients 48 hours after administration of this regimen. (Sub-study A)
  • To determine if a greater decrease in diastolic dysfunction in these patients at 48 hours is predictive of greater decrease in systolic function at 3 weeks after treatment with this regimen. (Sub-study A)
  • To determine whether levels of certain biomarkers of cardiac myocyte damage, B-type natriuretic peptide and the sarcomere protein troponin T at 48 hours after the initial exposure to these drugs correlate with relative risk of developing ≥ NCI grade1 cardiotoxicity. (Sub-study A)
  • To determine whether trastuzumab given concurrently with doxorubicin hydrochloride decreases heart rate variability and increases plasma levels of norepinephrine in these patients, and if so, whether these changes correlate with relative risk of developing NCI grade ≥ 1 cardiotoxicity. (Sub-study B)
  • To determine whether EPC number obtained from patients treated with trastuzumab have decreased migration into microvascular structures in an ex vivo assay and whether these changes correlate with ≥ NCI grade 1 cardiotoxicity. (Sub-study B)
  • To determine whether levels of certain biomarkers in these patients , including neuregulin, IGF-1, cardiotrophin-1, IL-6, VEGF, hepatocyte growth factor and heparin binding EGF, change after exposure to trastuzumab. (Sub-study B)

OUTLINE: This is a multicenter study.

  • Primary study: Patients make an initial visit (before beginning doxorubicin hydrochloride treatment) and a visit 3 weeks after the 4th course of doxorubicin hydrochloride (approximately 12 weeks after the initial visit). During these visits, blood samples are also collected for measuring serum levels of neuregulin-1, IGF-1, cardiotropin-1, IL-6, VEGF, hepatocyte growth factor, and plasma norepinephrine and endothelial progenitor cells (EPC). Heart-rate variability (HRV) is measured and, if necessary, a transthoracic echocardiogram is performed. Patients complete baseline health and activity level questionnaire and suitable patients complete a 6-minute walk test. Patients undergo blood collection for genotype analysis for single nucleotide polymorphism sites during the initial visit.

Patients complete a questionnaire assessing physical activity at the beginning of the 2nd, 3rd, and 4th courses of chemotherapy.

  • Sub-study A (MRI)*: In addition to the assessments performed in the primary study, patients undergo some extra tests. During initial visit, patients have an additional blood sample collected during initial visit for measurement of B-type natriuretic peptide (BNP) and troponin T and undergo cardiac MRI. Approximately 48 hours after the first dose of doxorubicin hydrochloride, patients undergo an additional visit, during which blood samples are collected for BNP and troponin T and an cardiac MRI is performed.

NOTE: *Patients who enroll in sub-study A must also be enrolled in the primary study.

  • Sub-study B (trastuzumab)*: In addition to the assessments performed in the primary study, patients undergo some extra tests. Patients undergo an additional visit after the third treatment of trastuzumab (approximately 6 months after the first dose of doxorubicin hydrochloride), during which patients have blood samples collected and analyzed as in Primary study visit 2. HRV is measured and, if necessary, a transthoracic echocardiogram is performed.

NOTE: *Patients who enroll in sub-study B must also be enrolled in the primary study.

After completion of study treatment, patients are followed periodically for up to 5 years .

  Eligibility

Ages Eligible for Study:   18 Years to 85 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population

Persons with newly diagnosed breast cancer with planned anthracycline-based chemotherapy.

Criteria

DISEASE CHARACTERISTICS:

  • Diagnosed with breast cancer

    • Receiving treatment at Vanderbilt Ingram Cancer Center and other participating oncology practices in middle Tennessee and southern Kentucky
  • Starting a standard doxorubicin hydrochloride regimen for 4 courses

    • Also scheduled to receive trastuzumab (for patients enrolled in sub-study B only)
  • No presence of metastatic disease
  • Hormone receptor status not specified

PATIENT CHARACTERISTICS:

  • Menopausal status not specified
  • Karnofsky performance status 60-100%
  • Not pregnant
  • Negative pregnancy test
  • Additional criteria for sub-study A (MRI):

    • Glomerular filtration rate ≥ 60 mL/min
    • No implanted electronic devices, cochlear implants, metallic implants, shrapnel or neurosurgical clips
    • No prior adverse reaction to gadolinium-based contrast agents
    • Must not exceed the weight limit or be too large to fit in the MRI scanner

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  • No prior anthracycline chemotherapy
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00875238

Locations
United States, Kentucky
University of Louisville James Graham Brown Cancer Center
Louisville, Kentucky, United States, 40202
United States, Tennessee
MBCCOP - Meharry Medical College - Nashville
Nashville, Tennessee, United States, 37208
Vanderbilt-Ingram Cancer Center
Nashville, Tennessee, United States, 37232-6838
Vanderbilt Heart One Hundred Oaks
Nashville, Tennessee, United States, 37204
Sponsors and Collaborators
Vanderbilt University
Investigators
Principal Investigator: Carrie G Lenneman, MD, MSCI Vanderbilt-Ingram Cancer Center & Univ. of Louisville
Principal Investigator: Daniel Lenihan, MD Vanderbilt University
Principal Investigator: Douglas B Sawyer, MD, PhD Vanderbilt University
  More Information

Additional Information:
Publications:
Responsible Party: Douglas Brian Sawyer, Professor of Medicine, Vanderbilt University
ClinicalTrials.gov Identifier: NCT00875238     History of Changes
Other Study ID Numbers: CDR0000613213, P30CA068485, VU-VICC-BRE-0767
Study First Received: April 2, 2009
Last Updated: August 5, 2014
Health Authority: United States: Institutional Review Board

Keywords provided by Vanderbilt University:
cardiac toxicity
cardiovascular complications
stage I breast cancer
stage II breast cancer
stage IIIA breast cancer
stage IIIB breast cancer
stage IIIC breast cancer

Additional relevant MeSH terms:
Breast Neoplasms
Neoplasms by Site
Neoplasms
Breast Diseases
Skin Diseases
Doxorubicin
Liposomal doxorubicin
Trastuzumab
Antibiotics, Antineoplastic
Antineoplastic Agents
Therapeutic Uses
Pharmacologic Actions
Topoisomerase II Inhibitors
Topoisomerase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action

ClinicalTrials.gov processed this record on August 28, 2014