Candesartan in Peripheral Neuropathy

Study Overview
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Brief Summary
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Background: Chemotherapy induced peripheral neuropathy (CIPN) is often painful, and is caused by neurotoxic chemotherapy including vincristine. It is a cause of significant impairment in quality of life in patients surviving to a solid cancer or malignant lymphoma. The only recognized prevention is based on pre-existing neuropathy and early detection of neuropathic signs and symptoms in individuals subjected to neurotoxic chemotherapy, justifying sometimes a change in the therapeutic strategy when other molecules are available. It seems obvious that to identify early markers of CIPN and to develop preventive therapeutic strategies, are priorities for improving patients' quality of life and enable them to follow optimal treatment. Purpose: To describe in patients treated for non-Hodgkin's type B malignant lymphoma with multidrug therapy containing vincristine, the impact of candesartan on the occurrence of neuropathy measured by the variation of TNSc (Total Neuropathy Score clinical version, evaluating clinical signs of neuropathy)

Official Title
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Pilot Study, Single-blind, Candesartan Versus Usual Care of Peripheral Neuropathy Development Induced by Vincristine (PNIV) in Patients Treated for Lymphoma B

Conditions
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Peripheral Neuropathy

Intervention / Treatment
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* Drug: Candesartan
* Other: Usual care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients aged 18 years and over and to be treated with Vincristine for non-Hodgkin B lymphoma (first line treatment) All the patients have to be treated with the same chemotherapy protocol (CHOP with or without Rituximab) to avoid confounding factors Normal renal function as measured by CKD-EPI > 30 mmol / min / 1.73 m2 Serum potassium < 5.5 mmol / l Systolic arterial pressure > 100 mm Hg (lying and standing position) affiliated with a social security For women of childbearing age: under highly effective contraception and negative pregnancy test at inclusion. Highly effective contraception: Combined hormonal contraceptive (containing estrogen and progesterone) (oral, intravaginal, or transdermal) or only progesterone (oral, injectable or implantable), Exclusion Criteria: Patients with pre-existing neuropathy, Chronic ethylism, HIV infection, etc. Patients under guardianship or unable for another reason to give informed consent. Intolerance to sartans Intolerance to excipients : galactose , lactose. Patients already treated with ACE inhibitors, ARBs or/and diuretics sparing

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Candesartan<br> | Drug: Candesartan<br>* Candesartan treatment with dose adjustments (8-16mg/day) during 6 months in accordance with adverse effects<br>|
| Active Comparator: Usual care<br> | Other: Usual care<br>* patients will be followed as usual<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| TNSc score variation between V1 and V4 | The primary endpoint in this clinical study is the V1 - V4 variation of the TNSc score TNSc is the Total Neuropathy Score Clinical version scale Validated 7-item TNSc quantifies subjective sensory and motor symptoms, vibration sensation, strength, and reflexes.Items are rated using a 0 to 4 scale and summed to obtain a total score ranging from 0 to 28. Higher scores reflect more severe neuropathy. The evaluation of the TNSc will be performed by a blinded evaluator of the randomization group | Between the base time (V1) and the end of chemotherapy (15 week later). | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| TNSc score variation between V1 and V3 | VariationVariation between V1 and V3 of the TNSc score. TNSc is the Total Neuropathy Score Clinical version scale Validated 7-item TNSc quantifies subjective sensory and motor symptoms, vibration sensation, strength, and reflexes.Items are rated using a 0 to 4 scale and summed to obtain a total score ranging from 0 to 28. Higher scores reflect more severe neuropathy. The evaluation of the TNSc will be performed by a blinded evaluator of the randomization group. | Between the base time (V1) and V3 (9 week later) | 
| Variation of visual analog scale (VAS) | Variation oh the VAS score between V1 - V3 and between V1- V4 The visual analogue scale (VAS) is commonly used as the outcome measure to characterize the intensity of pain . It is presented as a 100-mm horizontal line on which the patient's pain intensity is represented by a point between the extremes of no pain at all and worst pain imaginable. Higher scores reflect more severe pain. | Between the base time (V1) and 9 week and 15 week later | 
| Adverse effects | any adverse/ side effect will be evaluated | At baseline and each cycle up to 16 week |