Enalapril in Treating Heart Damage Patients Who Received Anthracycline Chemotherapy for Childhood Cancer

Study Overview
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Brief Summary
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RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Chemoprotective drugs, such as enalapril, may protect normal cells from the toxic effects of chemotherapy. It is not known whether enalapril is more effective than a placebo in treating heart damage in patients who received anthracycline chemotherapy for childhood cancer. PURPOSE: Randomized double-blinded phase III trial to compare the effectiveness of enalapril with a placebo in treating heart damage in patients who received anthracycline chemotherapy for childhood cancer.

Detailed Description
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OBJECTIVES: I. Determine whether enalapril treatment results in a reduction in body surface area-adjusted left ventricular mass in anthracycline-treated survivors of childhood cancer. II. Determine whether improvement in ventricular function achieved by enalapril is sustained and alters the course of late cardiotoxicity. III. Determine the impact of enalapril therapy on quality of life. OUTLINE: This is a double blind, placebo controlled, randomized study. Patients are stratified based on the cumulative anthracycline dose, age at cancer diagnosis, and the duration of time since cessation of anthracycline therapy. Patients are administered enalapril or placebo by mouth bid. Patients undergo a series of cardiac tests after administration of drug. Follow-up occurs at 2, 6, and 12 months and every year thereafter. PROJECTED ACCRUAL: 75 patients in each treatment arm will be accrued.

Official Title
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Afterload Reduction Therapy for Late Anthracycline Cardiotoxicity: A Pediatric Oncology Group Cancer Control Study

Conditions
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Cardiac Toxicity, Unspecified Childhood Solid Tumor, Protocol Specific

Intervention / Treatment
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* Drug: enalapril maleate
* Procedure: quality-of-life assessment


Participation Criteria
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Eligibility Criteria
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DISEASE CHARACTERISTICS: Histologically diagnosed childhood malignancy that had prior anthracycline therapy Echocardiographic evidence of reduced fractional shortening, reduced contractility, or increased afterload, or any combination At least 6 months oncologic disease free PATIENT CHARACTERISTICS: Age: At least 8 at study entry and less than 22 at diagnosis Performance status: Not specified Life expectancy: Not specified Hematopoietic: Not specified Hepatic: Not specified Renal: No history of renal disease No known renal artery stenosis Cardiovascular: No congenital cardiovascular malformations No active congestive heart failure not attributable to sepsis or renal failure No medication for heart condition No history of symptomatic arrhythmia antedating anthracycline therapy No constrictive pericarditis No uncontrolled hypertension Pulmonary: No primary valvular or outflow tract obstruction Other: Not pregnant or lactating Must use adequate contraception No reaction or intolerance to ACE inhibitors PRIOR CONCURRENT THERAPY: Biologic therapy: Not specified Chemotherapy: At least 1 year since prior cumulative anthracycline therapy of at least 200 mg/m2 No prior amsacrine therapy Endocrine therapy: Not specified Radiotherapy: No prior mediastinal, spinal, or total body irradiation that included the heart Surgery: Not specified Other: No concurrent angiotensin converting enzyme (ACE)inhibitor treatment No concurrent treatment with other investigational drug No oncologic therapy within past 6 months

Ages Eligible for Study
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Minimum Age: 8 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: Supportive Care
Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Stratum 1 < 350/mg/m2 anthracycline dose<br>< 4 years of age at diagnosis < 4 years since cessation of anthracycline treatment | Drug: enalapril maleate<br> <br> Procedure: quality-of-life assessment<br> <br> |
| Experimental: Stratum 2 < 350mg/m2 anthracycline dose<br>< 4 years of age at diagnosis >= 4 years since cessation of anthracycline treatment | Drug: enalapril maleate<br> <br> Procedure: quality-of-life assessment<br> <br> |
| Experimental: Stratum 3 < 350mg/m2 anthracycline dose<br>>= 4 years of age at diagnosis < 4 years since cessation of anthracycline treatment | Drug: enalapril maleate<br> <br> Procedure: quality-of-life assessment<br> <br> |
| Experimental: Stratum 4 < 350mg/m2 anthracycline dose<br>>= 4 years of age at diagnosis >= 4 years since cessation of anthracycline treatment | Drug: enalapril maleate<br> <br> Procedure: quality-of-life assessment<br> <br> |
| Experimental: Stratum 5 >= 350mg/m2 anthracycline dose<br>< 4 years of age at diagnosis < 4 years since cessation of anthracycline treatment | Drug: enalapril maleate<br> <br> Procedure: quality-of-life assessment<br> <br> |
| Experimental: Stratum 6 >=350mg/m2 anthracycline dose<br>< 4 years of age at diagnosis < 4 years since cessation of anthracycline treatment | Drug: enalapril maleate<br> <br> Procedure: quality-of-life assessment<br> <br> |
| Experimental: Stratum 7 >= 350mg/m2 anthracycline dose<br>>= 4 years of age at diagnosis < 4 years since cessation of anthracycline treatment | Drug: enalapril maleate<br> <br> Procedure: quality-of-life assessment<br> <br> |
| Experimental: Stratum 8 >= 350mg/m2 anthracycline dose<br>>= 4 years of age at diagnosis >= 4 years since cessation of anthracycline treatment | Drug: enalapril maleate<br> <br> Procedure: quality-of-life assessment<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cardiac functional status and quality of life | Cardiac functional status (depressed fractional shortening) and quality-of-life, will be assessed at baseline, two and five years into the study. | baseline, two and five years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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unspecified childhood solid tumor, protocol specific, cardiac toxicity