E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Myocardial toxicity and the development of left ventricular systolic dysfunction |
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E.1.1.1 | Medical condition in easily understood language |
A decrease in how well the heart muscles function |
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E.1.1.2 | Therapeutic area | Diseases [C] - Cardiovascular Diseases [C14] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10007612 |
E.1.2 | Term | Cardiac troponin I increased |
E.1.2 | System Organ Class | 100000004848 |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10069501 |
E.1.2 | Term | Left ventricular systolic dysfunction |
E.1.2 | System Organ Class | 100000004849 |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To determine whether known treatments for heart failure can prevent or reduce myocardial injury and the development of left ventricular systolic dysfunction. |
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E.2.2 | Secondary objectives of the trial |
To establish whether a novel highly sensitive plasma marker of myocardial injury can anticipate the development and monitor progression of left ventricular systolic dysfunction. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
• Female or male aged ≥18 years • Histological diagnosis of invasive breast cancer or non-Hodgkin lymphoma • ECOG performance status 0-1 • Planned to commence anthracycline containing therapy o for adjuvant or neo-adjuvant treatment of breast cancer. Breast cancer patients scheduled for ≥300 mg/m2 cumulative dose epirubicin, or equivalent, over 3, 4 or 6 cycles or o NHL patients planned to commence ≥3 cycles of CHOP or R-CHOP therapy containing ≥300mg/m2 epirubicin equivalent cumulative dose of anthracycline. • A life expectancy of at least 12 months • LVEF ≥ 50% on baseline MRI • Systolic blood pressure ≥ 105 mmHg and ≤170 mmHg • An eGFR >45 mL/min/1.73 m2 • Provide written consent to take part in the study |
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E.4 | Principal exclusion criteria |
• Pregnancy or breastfeeding • HER2 positive breast disease with planned trastuzumab therapy • Uncontrolled arterial hypertension defined as systolic blood pressure on treatment of >170 mmHg • Patients already taking B-blockers, ACEi or ARBs • Contra-indication to ARBs (eGFR ≤ 45 mL/min/1.73 m2, previous hypersensitivity, renal artery stenosis) or B-blockers (asthma, pathological heart block and, pathological sinus bradycardia. • Clinically proven intolerance to lactose monohydrate • A history of symptomatic heart failure • Contraindication to or inability to tolerate MRI scanning • Suspected poor drug compliance • Active alcohol or drug abuse • Patients previously treated with anthracyclines or trastuzumab • Uncontrolled concomitant serious illness, as determined by the investigator • Female or male aged < 18 years • Not provided written consent to take part in the study • Previously randomised into this trial |
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E.5 End points |
E.5.1 | Primary end point(s) |
The primary outcome measure will be a change in LVEF on cardiac MRI scan conducted 6 months after final anthracycline dose compared to baseline cardiac MRI scan conducted before anthracycline therapy starts between (randomised) treatment groups.
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Six months after the final anthracycline dose. |
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E.5.2 | Secondary end point(s) |
1. Specificity of cTnI assay for left ventricular dysfunction: Post treatment LVEF will be recorded with cardiac MRI in all non-randomised patients and compared to baseline LVEF to define the specificity of the hs-cTnI assay for identifying low-risk patients who do not develop left ventricular systolic dysfunction. 2. The development of asymptomatic left ventricular dysfunction (a 10 percentage point fall or an LVEF less than 50%). 3. Resolution of myocardial injury. Where plasma cTnI concentrations return to the normal reference range (less than 5 ng/L) at 2, 4 and 6 months after chemotherapy. 4. Clinical endpoints of death, cardiovascular death and heart failure. Heart failure will be defined by the diagnosis of clinical (symptomatic) heart failure (see below for definition). 5. Health economics for all enrolled patients: Confirm the feasibility of data capture and assess the quality of data obtainable in this patient population. Provide information that can inform the design of further research including sample size calculation and/or value of information analysis. 6. Heart rate and blood pressure at 2, 4 & 6 months following final dose of anthracycline. 7. Clinical endpoints of Hypotension, Bradycardia, Hyperkalaemia, Worsening renal function, Acute kidney injury, Fatigue grade ≥2 by CTCAE classification, New diagnosis of Atrial Fibrillation |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
2 months and 6 months after the final anthracycline dose. |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | Yes |
E.6.2 | Prophylaxis | Yes |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | No |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | Yes |
E.8.1.7.1 | Other trial design description |
Open-label blinded end point |
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E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 1 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 11 |
E.8.5 | The trial involves multiple Member States | No |
E.8.5.1 | Number of sites anticipated in the EEA | 11 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 3 |
E.8.9.1 | In the Member State concerned months | 7 |
E.8.9.1 | In the Member State concerned days | 1 |
E.8.9.2 | In all countries concerned by the trial years | 3 |
E.8.9.2 | In all countries concerned by the trial months | 6 |
E.8.9.2 | In all countries concerned by the trial days | 1 |