Cardioprotective Effects of Nebivolol Versus Placebo in Patients Undergoing Chemotherapy With Anthracyclines

Trial Title: Cardioprotective Effects of Nebivolol Versus Placebo in Patients Undergoing Chemotherapy With Anthracyclines

NCT ID: NCT05728632

Condition: Breast Cancer
Lymphoma, Large B-Cell, Diffuse
Cardiotoxicity
Left Ventricular Dysfunction
Chemotherapy Effect

Conditions: Official terms:
Lymphoma, Large B-Cell, Diffuse
Ventricular Dysfunction
Cardiotoxicity
Ventricular Dysfunction, Left
Nebivolol

Conditions: Keywords:
anthracycline chemotherapy
nebivolol
cardio-oncology
cancer therapy-related cardiovascular toxicity
cardiac magnetic resonance
primary prevention
cardioprotection
cardiotoxicity

Study type: Interventional

Study phase: Phase 3

Overall status: Active, not recruiting

Study design:

Allocation: Randomized

Intervention model: Parallel Assignment

Intervention model description: Participants are randomized 1:1 to two groups in parallel for the duration of the study

Primary purpose: Prevention

Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)

Masking description: Patients, treating physicians, investigators, and outcome assessors are masked to the allocated treatment.

Intervention:

Intervention type: Drug
Intervention name: Nebivolol
Description: Nebivolol, capsule, 5 mg once daily, for 12 months
Arm group label: Nebivolol

Other name: Lobivon

Intervention type: Drug
Intervention name: Placebo
Description: Placebo, capsule, once daily, for 12 months
Arm group label: Placebo

Summary: As the cancer-related prognosis improves thanks to recent advances in cancer-targeted therapies, the prognostic burden of chemotherapy-related complications - including cardiotoxicity - is increasingly recognised. So far, the evidence supporting pharmacological preventive strategies in cardio-oncology has been inconsistent and conflicting, and there is a clear need for well-designed trials with novel interventions. In this study, by using cardiac magnetic resonance, the investigators want to assess if a commonly used beta-blocker with a unique pharmacological profile, i.e. nebivolol, can prevent cardiac dysfunction in patients with breast cancer or diffuse large B-cell lymphoma undergoing chemotherapy with anthracyclines.

Detailed description: During the last decades, major efforts have been made in the field of cancer therapy to improve prognosis and quality of life of patients treated with any sort of chemotherapy. Cardiotoxicity represents one of the most relevant adverse effects of chemotherapy, primarily in patients treated with anthracyclines. The potential protective role of cardiovascular medications in the prevention of cardiotoxicity associated with anthracyclines chemotherapy is still a matter of debate since evidence in this field are scarce and largely inconclusive. Indeed, prior studies were often limited by a non-blinded design or an echocardiography-based assessment of left ventricular ejection fraction (with a relevant inter and intra-operator variability). The primary objective of the trial is to evaluate the cardioprotective effects of the betablocker nebivolol in an individually randomized, parallel, placebo-controlled, double-blinded (patient, treating physician, investigator, outcomes assessor, statistician), superiority trial in patients with a solid tumor (i.e., breast cancer) or a hematologic malignancy (i.e., diffuse large B cell lymphoma) who have a normal cardiac function as assessed by echocardiography and will receive anthracyclines as part of their first-line chemotherapy program. Indeed, recent evidence suggests that anthracycline cardiotoxicity seems mainly due to an anthracycline-induced dysregulation of mitochondrial activity and metabolism in cardiomyocytes. Nebivolol has a distinctive profile among beta-blockers, with the unique power of increasing the nitric oxide bioavailability. Nebivolol-induced nitric oxide release has shown favourable effects in terms of antioxidant activity, cardiac neo-angiogenesis, mitochondrial and endothelial protection. On this basis, the individually randomized, parallel, placebo-controlled, double-blinded (patient, treating physician, investigator, outcomes assessor, statistician), superiority CONTROL trial will assess the cardioprotective effects of a commonly used betablocker (nebivolol) in patients with baseline normal left ventricular systolic function receiving anthracycline chemotherapy as first-line chemotherapy for breast cancer or diffuse large B-cell lymphoma. The assessment of left ventricular ejection fraction and related endpoints will be performed with cardiac magnetic resonance.

Criteria for eligibility:
Criteria:
Inclusion Criteria: - Age ≥18 years - Established histologic diagnosis of breast cancer or diffuse large B-cell lymphoma - Planned chemotherapy with anthracyclines - left ventricular ejection fraction ≥55% (assessed by echocardiography) - Ability to provide informed consent Exclusion Criteria: - Known intolerance/contraindications to betablocker therapy - History of coronary artery disease - History of cardiomyopathy - History of heart failure - Ongoing treatment with betablockers for other indications - Heart rate at baseline <60 beats per minute - Arterial blood pressure at baseline <100/60 mmHg - Contraindications to undergo cardiac magnetic resonance (e.g., non-compatible pacemakers or metallic prosthesis) - Pregnancy or lactation - Current participation to another study

Gender: All

Minimum age: 18 Years

Maximum age: N/A

Healthy volunteers: No

Locations:

Facility:
Name: IRCCS Humanitas Research Hospital

Address:
City: Rozzano
Zip: 20089
Country: Italy

Start date: January 1, 2019

Completion date: February 28, 2023

Lead sponsor:
Agency: Giulio Stefanini
Agency class: Other

Collaborator:
Agency: Agenzia Italiana del Farmaco
Agency class: Other

Source: Humanitas Hospital, Italy

Record processing date: ClinicalTrials.gov processed this data on November 12, 2024

Source: ClinicalTrials.gov page: https://clinicaltrials.gov/ct2/show/NCT05728632