Rationale and design of the cardiac CARE Trial: a randomized trial of troponin-guided neurohormonal blockade for the prevention of anthracycline cardiotoxicity
Authors
Henriksen, P. A.Hall, P.
Oikonomidou, O.
MacPherson, I. R.
Maclean, M.
Lewis, S.
McVicars, H.
Broom, A.
Scott, F.
McKay, P.
Borley, A.
Rowntree, C.
Lord, S.
Collins, G.
Radford, John A
Guppy, A.
Payne, J. R.
Newby, D. E.
Mills, N. L.
Lang, N. N.
Affiliation
BHF Centre for Cardiovascular Science University of Edinburgh, United KingdomIssue Date
2022
Metadata
Show full item recordAbstract
Background: Anthracyclines are effective cytotoxic drugs used in the treatment of breast cancer and lymphoma but are associated with myocardial injury, left ventricular dysfunction, and heart failure. Anthracycline-induced cardiotoxicity is highly variable in severity and without a proven therapeutic intervention. β-Adrenergic receptor blockers and renin-angiotensin-system inhibitor therapies have been associated with modest cardioprotective effects in unselected patients. Methods: The Cardiac CARE trial is a multicentre prospective randomized open-label blinded end point trial of combination β-adrenergic receptor blocker and renin-angiotensin-system inhibitor therapy in patients with breast cancer and non-Hodgkin lymphoma receiving anthracycline chemotherapy that is associated with myocardial injury. Patients at higher risk of cardiotoxicity with plasma high-sensitivity cTnI (cardiac troponin I) concentrations in the upper tertile at the end of chemotherapy are randomized to standard of care plus combination candesartan and carvedilol therapy or standard of care alone. All patients undergo cardiac magnetic resonance imaging before and 6 months after anthracycline treatment. The primary end point is the change in left ventricular ejection fraction at 6 months after chemotherapy. In low-risk nonrandomized patients, left ventricular ejection fraction before and 6 months after anthracycline will be compared with define the specificity of the high-sensitivity cTnI assay for identifying low-risk participants who do not develop left ventricular systolic dysfunction. Discussion: Cardiac CARE will examine whether cardiac biomarker monitoring identifies patients at risk of left ventricular dysfunction following anthracycline chemotherapy and whether troponin-guided treatment with combination candesartan and carvedilol therapy prevents the development of left ventricular dysfunction in these high-risk patients.Citation
Henriksen PA, Hall P, Oikonomidou O, MacPherson IR, Maclean M, Lewis S, et al. Rationale and Design of the Cardiac CARE Trial: A Randomized Trial of Troponin-Guided Neurohormonal Blockade for the Prevention of Anthracycline Cardiotoxicity. Circulation Heart failure. 2022 Jul;15(7):e009445. PubMed PMID: 35766037. Epub 2022/06/30. eng.Journal
Circulation. Heart FailureDOI
10.1161/circheartfailure.121.009445PubMed ID
35766037Additional Links
https://dx.doi.org/10.1161/circheartfailure.121.009445Type
ArticleLanguage
enae974a485f413a2113503eed53cd6c53
10.1161/circheartfailure.121.009445
Scopus Count
Collections
Related articles
- Multicenter, Prospective, Randomized Controlled Trial of High-Sensitivity Cardiac Troponin I-Guided Combination Angiotensin Receptor Blockade and Beta-Blocker Therapy to Prevent Anthracycline Cardiotoxicity: The Cardiac CARE Trial.
- Authors: Henriksen PA, Hall P, MacPherson IR, Joshi SS, Singh T, Maclean M, Lewis S, Rodriguez A, Fletcher A, Everett RJ, Stavert H, Broom A, Eddie L, Primrose L, McVicars H, McKay P, Borley A, Rowntree C, Lord S, Collins G, Radford J, Guppy A, Williams MC, Japp A, Payne JR, Newby DE, Mills NL, Oikonomidou O, Lang NN
- Issue date: 2023 Nov 21
- Rationale and design of the Children's Oncology Group (COG) study ALTE1621: a randomized, placebo-controlled trial to determine if low-dose carvedilol can prevent anthracycline-related left ventricular remodeling in childhood cancer survivors at high risk for developing heart failure.
- Authors: Armenian SH, Hudson MM, Chen MH, Colan SD, Lindenfeld L, Mills G, Siyahian A, Gelehrter S, Dang H, Hein W, Green DM, Robison LL, Wong FL, Douglas PS, Bhatia S
- Issue date: 2016 Oct 4
- Neurohormonal Blockade and Circulating Cardiovascular Biomarkers During Anthracycline Therapy in Breast Cancer Patients: Results From the PRADA (Prevention of Cardiac Dysfunction During Adjuvant Breast Cancer Therapy) Study.
- Authors: Gulati G, Heck SL, Røsjø H, Ree AH, Hoffmann P, Hagve TA, Norseth J, Gravdehaug B, Steine K, Geisler J, Omland T
- Issue date: 2017 Nov 8
- Cardioprotective role of β-blockers and angiotensin antagonists in early-onset anthracyclines-induced cardiotoxicity in adult patients: a systematic review and meta-analysis.
- Authors: Yun S, Vincelette ND, Abraham I
- Issue date: 2015 Nov