Imaging Versus Cardiac Biomarker Monitored HER2 Directed Therapy in Patients With Breast Cancer

NCT ID: NCT05406635

Last Updated: 2025-04-08

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

220 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-10-01

Study Completion Date

2027-09-01

Brief Summary

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Due to a risk of heart failure during HER2 directed therapy in breast cancer, treatment is monitored with imaging of myocardial function, which is resource demanding for both patients and the health care system. The purpose of this study is to evaluate, if biomarkers can replace imaging based examinations of myocardial function during HER2 directed therapy.

Detailed Description

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About 15% of breast cancer tumors express the Human Epidermal Growth Factor Receptor 2 (HER2), which is associated with a poor prognosis. Antibodies (trastuzumab and pertuzumab) directed against HER2 have in addition to traditional chemotherapy significantly improved survival in HER2 positive breast cancer, but induce a risk of left ventricular dysfunction and heart failure. Regular imaging based evaluation of myocardial function is therefore recommended during HER2 directed therapy by either an echocardiography or a MUGA scan, which is associated with radiation exposure. Both types of scans are resources demanding for both patients and the healthcare system, and since biomarkers have been proposed as another modality in assessment of myocardial injury, the purpose of this study is to evaluate, if biomarkers can replace imaging based examinations of myocardial function during HER2 directed therapy.

The study is designed as a national multicenter, randomized study, which will include Odense University Hospital, Herlev and Gentofte University Hospital and Aarhus University Hospital. It will be possible to include more sites.

Patients with localized HER2-positive breast cancer scheduled for HER2 proper therapy will be randomized 1: 1 to:

1. Standard imaging monitored treatment as recommended by DBCG guidelines with measurement of LVEF by MUGA scan or echocardiography in weeks 0, 9, 18, 30 and 48 of the treatment period. At each control visit, biomarkers are also taken, which are blinded until the end of the study.
2. Biomarker monitored treatment with measurement of NT-proBNP and cTNT / TNI in weeks 0, 9, 18, 30 and 48 of the treatment period. At each of these follow-up visits, MUGA scans or echocardiography are also performed, but the results are blinded to the staff responsible for treatment decisions.

In the group followed by standard imaging monitoring, cardiotoxicity will be managed according to standard clinical guidelines. Cardiotoxicity in the biomarker group will be suspected in case of a doubling of NT-proBNP from baseline (but minimum 125 pg / ml) and / or an increase in troponins to above 99th percentile. If these criteria are met, imaging is triggered, which in practice is a blinding of the result of the examination already performed.

The primary endpoint of the study is LVEF measured by cardiac MRI scan three months after completion of HER2-directed therapy.

Conditions

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Cardiotoxicity HER2-positive Breast Cancer

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Caregivers

Study Groups

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Standard imaging monitored treatment

Standard care + biomarkers, which are blinded until end of study.

Group Type NO_INTERVENTION

No interventions assigned to this group

Intervention biomarker monitored treatment

biomarker monitored treatment + imaging, which is blinded until end of study

Group Type EXPERIMENTAL

Biomarkers: Troponins and natriuretic peptides

Intervention Type DIAGNOSTIC_TEST

Biomarker monitored treatment with measurement of NT-proBNP and cTNT / TNI in weeks 0, 9, 18, 30 and 48 of the treatment period.

Interventions

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Biomarkers: Troponins and natriuretic peptides

Biomarker monitored treatment with measurement of NT-proBNP and cTNT / TNI in weeks 0, 9, 18, 30 and 48 of the treatment period.

Intervention Type DIAGNOSTIC_TEST

Eligibility Criteria

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Inclusion Criteria

* Patients with non-metastatic HER2 positive breast cancer
* Scheduled for standard chemotherapy and HER2 directed therapy with trastuzumab +/- pertuzumab
* Age \> 18 years
* Sinus rhythm on ECG
* NT-proBNP below125 pg/ml
* Troponin below threshold limit value
* LVEF \> 55% by MUGA scan or an echocardiogram

Exclusion Criteria

* Contra indications for cardiac magnetic resonance imaging (CMRI)
* Chronic obstructive pulmonary disease with FEV1 \<80 % of predicted
Minimum Eligible Age

18 Years

Maximum Eligible Age

90 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Aarhus University Hospital

OTHER

Sponsor Role collaborator

Aalborg University Hospital

OTHER

Sponsor Role collaborator

University of Copenhagen

OTHER

Sponsor Role collaborator

Odense University Hospital

OTHER

Sponsor Role lead

Responsible Party

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Ann Banke

Principal Investigator, Medical Doctor, PHD

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Ann Banke, MD PHD

Role: PRINCIPAL_INVESTIGATOR

Odense Universitetshospital

Locations

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Aalborg University Hospital

Aalborg, , Denmark

Site Status RECRUITING

Rigshospitalet

Copenhagen, , Denmark

Site Status RECRUITING

Herlev University Hospital

Herlev, , Denmark

Site Status NOT_YET_RECRUITING

Odense University Hospital

Odense, , Denmark

Site Status RECRUITING

Countries

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Denmark

Central Contacts

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Ann Banke, MD, PHD

Role: CONTACT

+4526278303

Facility Contacts

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Marie Louise Milo, MD

Role: primary

Maja Maraldo

Role: primary

Anne Polk, MD, PHD

Role: primary

Ann Banke, MD, PHD

Role: primary

+4526278303

Related Links

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https://open.rsyd.dk/OpenProjects/openProject.jsp?openNo=1413&lang=da

Link to study description af Open Patient data Explorative Network

Other Identifiers

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OP_1413

Identifier Type: -

Identifier Source: org_study_id

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