Clinical trial NCT02573584: Vascular Fingerprint Validation Study
Official title: Vascular Fingerprint to Identify Patients at Risk for Arterial Cardiovascular Events Within the First Year After Start of Cisplatin-based Chemotherapy for Testicular Cancer: a Validation Study
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Testicular Cancer
Lead sponsor: University Medical Center Groningen
Sponsor class: OTHER
First posted: 2015-10-12
Enrollment: 101
Sex: MALE
Minimum age (years): 18
Maximum age (years): 50
Standard ages: ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: PROBABILITY_SAMPLE
Study population: Newly diagnosed testicular cancer patients before start of chemotherapy.

Brief summary: The vascular fingerprint is a simple selection tool to identify testicular cancer patients with a high risk of arterial cardiovascular events during and in the first year after cisplatin chemotherapy. Eventually, this selection method allows a relative small randomized intervention study with i.e. LMWH during chemotherapy to prove the effectiveness and safety in lowering the chance of an arterial cardiovascular event.

Detailed description: Since the introduction of cisplatin in the late seventies (1), the prognosis of metastatic testicular cancer patients has dramatically improved, with long-term survival rates of 80-90% (2). However, cure rates are compromised by the increased risk of cardiovascular events (3-5). Approximately 1-5% of the patients with metastatic testicular cancer develop arterial cardiovascular events during or shortly after cisplatin- and bleomycin containing chemotherapy (3-7). Arterial cardiovascular events include ischemic stroke and myocardial infarction. These arterial events are a source of serious treatment-induced morbidity and mortality as recently clearly confirmed by Fung (8). No established standard prophylaxis is available. There is an unmet need to have the possibility to identify high risk patients before start of chemotherapy in whom prophylactic anti-coagulant treatment may prevent events (9). An identification tool could maximize the benefit of an intervention without introducing too much unnecessary harm: preventive interventions also carry risk.

Recent data from the investigators' cancer center showed that before chemotherapy 22% of the metastatic cancer patients had ≥3 of the following 5 traditional cardiovascular risk factors present (high risk vascular fingerprint, figure 1): overweight, smoking, hypertension, dyslipidemia and impaired blood glucose. These patients had an increased risk to develop arterial events during or early after chemotherapy: 19% of the patients with a high risk vascular fingerprint developed an arterial cardiovascular event whereas only 2% of the patients with ≤2 risk factors developed an event . The vascular fingerprint seems an easy method to identify which metastatic testicular cancer patients are at a high risk for early arterial events and who may benefit from prophylaxis with for example low molecular weight heparins (LMWHs). To be used in the clinic these data need to be confirmed in an independent cohort.

Eligibility criteria: Inclusion Criteria:

1. Diagnosis of metastatic TC and an indication to start with first-line cisplatin-based chemotherapy for metastatic TC
2. Classified into IGCCCG good or intermediate prognosis group
3. Younger than 50 years of age at start of chemotherapy
4. Signed informed consent

Exclusion Criteria:

1. History of previous cardiovascular disease
2. Retroperitoneal mass \> 5 cm
3. Indication for anticoagulant therapy at start of chemotherapy

Primary outcomes:
measure: Development of arterial cardiovascular events
timeFrame: first year after start of chemotherapy
Secondary outcomes:
measure: Overall survival
timeFrame: first year after start of chemotherapy
measure: Response to testicular cancer treatment (no evidence of disease / relapse / no response to treatment)
timeFrame: first year after start of chemotherapy
measure: Development of venous thromboembolic events (VTE) (WHO ICD-10 I26, I80-82)
timeFrame: first year after start of chemotherapy
Other outcomes:
Locations:
city: Amsterdam
country: Netherlands
facility: Nederlands Kanker Instituut - Antoni van Leeuwenhoek ziekenhuis (NKI-AVL)
city: Groningen
country: Netherlands
facility: University Medical Center Groningen (UMCG)
city: Maastricht
country: Netherlands
facility: Maastricht University Medical Center (MUMC)
city: Lisbon
country: Portugal
facility: Instituto Portuges de Oncologia Francisco Gentil (IPOLFG)
city: Zurich
country: Switzerland
facility: UniversitatsSpital Zurich
Study officials:
affiliation: University Medical Center Groningen
name: Jourik A Gietema, MD, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Einhorn LH, Donohue J. Cis-diamminedichloroplatinum, vinblastine, and bleomycin combination chemotherapy in disseminated testicular cancer. Ann Intern Med. 1977 Sep;87(3):293-8. doi: 10.7326/0003-4819-87-3-293.
citation: DeSantis CE, Lin CC, Mariotto AB, Siegel RL, Stein KD, Kramer JL, Alteri R, Robbins AS, Jemal A. Cancer treatment and survivorship statistics, 2014. CA Cancer J Clin. 2014 Jul-Aug;64(4):252-71. doi: 10.3322/caac.21235. Epub 2014 Jun 1.
citation: Weijl NI, Rutten MF, Zwinderman AH, Keizer HJ, Nooy MA, Rosendaal FR, Cleton FJ, Osanto S. Thromboembolic events during chemotherapy for germ cell cancer: a cohort study and review of the literature. J Clin Oncol. 2000 May;18(10):2169-78. doi: 10.1200/JCO.2000.18.10.2169.
citation: Piketty AC, Flechon A, Laplanche A, Nouyrigat E, Droz JP, Theodore C, Fizazi K. The risk of thrombo-embolic events is increased in patients with germ-cell tumours and can be predicted by serum lactate dehydrogenase and body surface area. Br J Cancer. 2005 Oct 17;93(8):909-14. doi: 10.1038/sj.bjc.6602791.
citation: Nuver J, Smit AJ, van der Meer J, van den Berg MP, van der Graaf WT, Meinardi MT, Sleijfer DT, Hoekstra HJ, van Gessel AI, van Roon AM, Gietema JA. Acute chemotherapy-induced cardiovascular changes in patients with testicular cancer. J Clin Oncol. 2005 Dec 20;23(36):9130-7. doi: 10.1200/JCO.2005.01.4092. Epub 2005 Nov 21.
citation: Dieckmann KP, Struss WJ, Budde U. Evidence for acute vascular toxicity of cisplatin-based chemotherapy in patients with germ cell tumour. Anticancer Res. 2011 Dec;31(12):4501-5.
citation: Dieckmann KP, Gerl A, Witt J, Hartmann JT; German Testicular Cancer Study Group. Myocardial infarction and other major vascular events during chemotherapy for testicular cancer. Ann Oncol. 2010 Aug;21(8):1607-1611. doi: 10.1093/annonc/mdp597. Epub 2010 Jan 12.
citation: Fung C, Fossa SD, Milano MT, Sahasrabudhe DM, Peterson DR, Travis LB. Cardiovascular Disease Mortality After Chemotherapy or Surgery for Testicular Nonseminoma: A Population-Based Study. J Clin Oncol. 2015 Oct 1;33(28):3105-15. doi: 10.1200/JCO.2014.60.3654. Epub 2015 Aug 3.
citation: Ramos JD, Yu EY. Cardiovascular Mortality in Testicular Nonseminomatous Germ Cell Tumors: Does Statistical Significance Imply Clinical Significance? J Clin Oncol. 2015 Oct 1;33(28):3075-7. doi: 10.1200/JCO.2015.62.7398. Epub 2015 Aug 24. No abstract available.
citation: Lubberts S, Boer H, Altena R, Meijer C, van Roon AM, Zwart N, Oosting SF, Kamphuisen PW, Nuver J, Smit AJ, Mulder AB, Lefrandt JD, Gietema JA. Vascular fingerprint and vascular damage markers associated with vascular events in testicular cancer patients during and after chemotherapy. Eur J Cancer. 2016 Aug;63:180-8. doi: 10.1016/j.ejca.2016.05.022. Epub 2016 Jun 17.