A groundbreaking phase II clinical trial is testing whether a simple, non-invasive intervention similar to a blood pressure reading could prevent heart failure in cancer survivors treated with anthracycline chemotherapy. The RESILIENCE project, funded by the European Commission's Horizon-2020 program, represents the first time a preventive intervention has been offered to cancer patients during treatment to reduce their long-term risk of heart failure.
The double-blinded, randomized trial has already recruited 355 participants, with 608 patients expected to enroll across 22 hospitals in six European countries: Spain, Germany, Portugal, Denmark, France, and the Netherlands. Participants are being treated for lymphoma or breast cancer with anthracyclines, highly effective chemotherapy drugs that carry significant cardiac risks.
Addressing a Critical Unmet Need
The clinical significance of this trial becomes clear when examining the scope of anthracycline-related cardiotoxicity in Europe. Of the four million Europeans diagnosed with cancer annually, three million receive anthracyclines as part of their treatment. Recent research indicates that approximately 35% of these patients will develop some form of cardiotoxicity, with around 6% experiencing moderate to severe cardiotoxicity that can include heart failure. Currently, one million people in Europe are living with chronic heart failure following cancer therapy-related heart damage.
"For many patients, the trade-off between cancer and potential heart damage can be horribly stressful," explained Professor Borja Ibáñez, coordinator of the RESILIENCE project and Scientific Director of the National Center for Cardiovascular Research in Spain. "This trial is testing a simple intervention, that patients can do themselves in their own home once a week during cancer treatment, to try to reduce their risk of heart damage."
Remote Ischemic Conditioning Mechanism
The intervention being tested is called Remote Ischemic Conditioning (RIC), which involves controlled periods of restricting blood flow (ischemia) and restoring blood flow (reperfusion) in a patient's limb. This technique has previously demonstrated efficacy in helping tissues and organs become more resilient to the damaging impacts of blood flow changes in conditions such as myocardial infarction and stroke.
The simplicity of the intervention is a key advantage. Patients can perform RIC at home once weekly during their cancer treatment, using equipment that applies tension similar to a blood pressure cuff. Professor Ibáñez emphasized the intervention's appeal: "The fact that the intervention is non-invasive with no known side-effects is a big bonus."
Comprehensive Research Approach
Beyond testing the primary intervention, the RESILIENCE project incorporates several innovative research components. The trial will investigate gender differences in cancer therapy-related heart damage and response to the RIC intervention, addressing an important gap in cardio-oncology research. Additionally, researchers will test a new MRI scanning protocol designed to detect cardiac damage in cancer patients earlier than current standard methods allow.
The patient-centered approach has been integral to the trial's design. "We have involved patients in the design of this trial, and it has been great to see how enthusiastic cancer patients are to take part and to understand the science behind the study," Professor Ibáñez noted.
Future Implications
If successful, this phase II trial could pave the way for larger-scale validation studies. "If the trial shows that this intervention reduces heart failure in cancer survivors, it will pave the way for an even larger phase III outcomes clinical trial," Professor Ibáñez stated.
The collaborative nature of the research represents a significant achievement in European cardio-oncology. "This trial has involved a truly remarkable collaboration between hospitals, research centres, industry partners and clinicians across six countries, alongside the critical role played by the European Society of Cardiology," Professor Ibáñez concluded. "The scale of this collaboration makes this a unique, landmark study in cardio-oncology."
The trial's potential impact extends beyond individual patient outcomes, potentially establishing a new standard of care that could prevent heart failure in hundreds of thousands of cancer survivors across Europe and globally.
