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Trial record 1 of 1 for:    emira | Breast Cancer | Netherlands
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Early Detection of Imaging-derived Subclinical Cardiac Injuries (EMIRA)

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ClinicalTrials.gov Identifier: NCT03575650
Recruitment Status : Recruiting
First Posted : July 2, 2018
Last Update Posted : February 28, 2024
Sponsor:
Collaborator:
Utrecht University
Information provided by (Responsible Party):
University Medical Center Groningen

Study Description
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Brief Summary:
Breast cancer (BC) radiotherapy leads to incidental cardiac irradiation, resulting in an increased risk of various major cardiac events (MCEs). In addition, recent studies indicate that for the treatment of BC, the addition of chemotherapy further enhances the risk of MCEs. Information regarding morphological and functional early subclinical cardiac injuries (ESCIs) induced by chemotherapy and radiotherapy that develop into MCEs is largely lacking in scientific literature. This information is essential towards the development of primary and secondary preventive strategies. The EMIRA prospective cohort has as main objective to identify morphological and functional ESCIs in BC patients treated with adjuvant radiotherapy and chemotherapy.

Condition or disease Intervention/treatment
Cardiovascular Diseases Other: Cardiac imaging modalities

Detailed Description:

EMIRA is a single centre prospective observational cohort study performed in the UMCG. The study includes breast cancer patients that underwent primary surgery, either by mastectomy or breast conserving surgery, who are treated with adjuvant radiotherapy and chemotherapy as part of routine clinical care. The patient follow up time continues for 2 years after radiotherapy to identify early subclinical cardiac injuries (ESCIs), using repeat echocardiography (cECHO), cardiac MRI (cMRI) scans and cardiac CT (cCT) scans. The images are acquired prior to chemotherapy and/or radiotherapy (depending on the sequence of adjuvant treatment), and at 6 and 24 months after radiotherapy The first primary aim of this project is to detect ESCIs that are considered risk factors for clinically apparent major cardiac events in breast cancer patients treated with radiotherapy and chemotherapy. The second is to use this information to develop prediction models describing the relationship between the radiation dose to cardiac substructures and ESCIs.

In detail, the investigators aim to:

  1. identify longitudinal morphological and functional ESCIs using echocardiography, cardiac MRI and cardiac CT before and after BC treatment;
  2. determine the relationship between 3D-dose distributions to cardiac substructures and ESCI;
  3. establish the effect of chemotherapy on the dose-effect relationship between radiation dose and ESCI.
Study Design
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Study Type : Observational
Estimated Enrollment : 148 participants
Observational Model: Cohort
Time Perspective: Prospective
Official Title: Early Detection of Imaging-derived Subclinical Cardiac Injuries After Radiotherapy and Chemotherapy for Breast Cancer
Actual Study Start Date : January 24, 2019
Estimated Primary Completion Date : September 2, 2024
Estimated Study Completion Date : September 2, 2024

Resource links provided by the National Library of Medicine


Groups and Cohorts
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Group/Cohort Intervention/treatment
Cardiac imaging modalities
Repeat echocardiography (cECHO), cardiac MRI (cMRI) scans and cardiac CT (cCT) scans will be performed to evaluate myocardial dysfunction and deformation; myocardium inclusing tissue abnormalities, cardiac morphology and function and; coronary artery lesions and coronary artery calcium score.
 Other: Cardiac imaging modalities
Repeat cardiac echocardiographies, MRI-scans and CT-scans for early subclinical biomarker assessments in breast cancer patients treated with chemotherapy and radiotherapy


Outcome Measures
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Primary Outcome Measures :
  1. Left Ventricle Global Longitudinal Strain (LV-GLS) assessed by echocardiography [ Time Frame: 6 and 24 months after radiotherapy with reference to baseline ]
    Increasement in left ventricle Global Longitudinal Strain (GLS) of at least 5%


Secondary Outcome Measures :
  1. Changes in myocardial function assessed by echocardiography [ Time Frame: 6 and 24 after completion of radiotherapy with reference to baseline ]
    Increasement of segmental strain measurements (unit of measures:%)

  2. Anatomical changes in coronary arteries by cardiac CT [ Time Frame: 6 and 24 after completion of radiotherapy with reference to baseline ]
    Increase in the number of coronary segments containing any plaque/stenosis, or increase in calcium score

  3. Myocardial tissue abnormalities assessed by cardiac MRI [ Time Frame: 6 and 24 after completion of radiotherapy with reference to baseline ]
    Increase of the native mean myocardial T1 mapping value assessed by cardiac MRI


Eligibility Criteria
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Ages Eligible for Study:   40 Years to 70 Years   (Adult, Older Adult)
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population
Female patients with unilateral BC aged 40-75 years who underwent primary surgery, either by mastectomy or by breast conserving surgery, who are treated with adjuvant radiotherapy and chemotherapy as part of routine clinical care.
Criteria

Inclusion Criteria:

  1. Female unilateral BC patients
  2. Primary breast conserving surgery or mastectomy for stage I-III invasive adenocarcinoma of the breast or ductal carcinoma in situ (DCIS)
  3. Age between 40-70 years at time of chemotherapy/radiotherapy
  4. WHO performance status 0-1
  5. Planned radiotherapy to the breast/chest wall with or without the lymph node areas
  6. Radiotherapy based on planning CT-scan, using either 3D CRT, (partial) IMRT or (partial) VMAT/RapidArc with or without deep inspiration breath-hold
  7. Adjuvant systemic chemotherapy (before or after radiotherapy)
  8. Written informed consent

Exclusion Criteria:

  1. Male BC patients
  2. M1 disease (metastatic BC)
  3. Previous thoracic or mediastinal radiation
  4. Neo-adjuvant chemotherapy not allowed
  5. Targeted HER2 therapy not allowed
  6. Medical history of coronary artery disease and/or myocardial infarction and/or atrial fibrillation
  7. Contraindications to injection of iodinated contrast such as allergy or renal failure
  8. Pregnancy or lactation
  9. Atrial fibrillation detected during electrocardiogram before chemotherapy/radiotherapy
  10. Abnormal echocardiography before chemotherapy/radiotherapy defined as: LVEF <50%, longitudinal strain <-16%, longitudinal strain rate <-1%, and/or abnormal wall motion
  11. Presence of myocardial infarction detected during cMRI before chemotherapy/radiotherapy
  12. cMRI or cCT results before chemotherapy/radiotherapy requiring revascularisation
Contacts and Locations
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Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03575650


Contacts
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Contact: Anne Crijns, MD, PhD +31503616161 a.p.g.crijns@umcg.nl

Locations
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Netherlands
UMCG Recruiting
Groningen, Netherlands, 9713GZ
Contact: Anne Crijns, MD PhD    +31-652724432    a.p.g.crijns@umcg.nl   
Sponsors and Collaborators
University Medical Center Groningen
Utrecht University
Investigators
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Study Chair: Hans Langendijk, Prof.Dr UMCG
More Information
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Responsible Party: University Medical Center Groningen
ClinicalTrials.gov Identifier: NCT03575650    
Other Study ID Numbers: 2018-06
First Posted: July 2, 2018    Key Record Dates
Last Update Posted: February 28, 2024
Last Verified: February 2024
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Cardiovascular Diseases