Vascular Toxicities of Immune ChecKpoint Inhibitors : From Bed to Benchside (VICKI)

Institut Mutualiste Montsouris

Status: Enrolling

Conditions: MSI-H Cancer; Bladder Cancer; Cancer; Renal Cell Carcinoma

Treatments: Diagnostic Test: Arterial Doppler for Flow Mediated Reserve measurement

Study type: Interventional

Funder types: Other

Identifiers

NCT06020651

CARDIO 05 2022

Details and patient eligibility

About

Immune checkpoint inhibitors (ICIs) are largely prescribed in a growing number of cancer diseases and at earlier stages (non metastatic cancer). Among immune-related adverse events, (iRAEs), the incidence of major cardiovascular events due to atherosclerosis reaches 13% at one year in patients at high risk. To the best of our knowledge, the mechanisms of this acceleration of atherosclerosis have not been studied to this date.

The VICKI study aims at furthering our knowledge on the mechanisms of atherosclerotic plaque instability by means of a prospective single-centre pilot study, by comparing:

• surrogate markers of clinical vasculo-toxicity with arterial Doppler (flow mediated reserve) as defined by the International Cardio-Oncology Society;
• circulating biomarkers

Before and after receiving ICIs for solid cancer treatment.

Full description

Context. Immune checkpoint inhibitors (ICIs) are largely prescribed in a growing number of cancer diseases and at earlier stages (non metastatic cancer). Among immune-related adverse events, (iRAEs), the incidence of major cardiovascular events due to atherosclerosis reaches 13% at one year in patients at high risk. To the best of our knowledge, the mechanisms of this acceleration of atherosclerosis have not been studied to this date.

Endothelial dysfunction is a predictor of the development of atherosclerotic plaque and events related to erosion or rupture. Endothelial dysfunction correlates well with the increase of circulating microparticles in various populations. The increase of circulating microparticles is also associated with major cardiovascular events.

The International society of Cardio-Oncology (IC-OS) recently published a definition for subclinical vascular toxicities due to ICIs. It includes non-invasive imaging methods readily available at the bedside (Herrmann et al. European Heart Journal 2022), largely replicated in the recent European Society of Cardiology (ESC) guidelines 2022. It includes the decrease of flow mediated reserve <7% or hyperhemia index <2; or the decrease of any of these biomarkers > 50% from baseline.

Aims and Methods. The VICKI study aims at furthering our knowledge on the mechanisms of atherosclerotic plaque instability by means of a prospective single-centre pilot study, by comparing:

• surrogate markers of clinical vasculo-toxicity with arterial Doppler (flow mediated reserve, hyperhemia index, plaque volume) as defined by IC-OS;
• circulating microparticles; Before and after receiving ICIs for solid cancer treatment.

The number of participants:

• 40 patients receiving ICIs for solid cancer (alone or in combination of other cancer drugs);
• 40 controls (matched by age, gender, cancer type) not treated by ICIs.

Duration of participation: up to 6 weeks. Inclusion period: 12 months.

Perspectives. The VICKI study may improve our understanding of the mechanisms of atherosclerosis mediated major cardiovascular events. If circulating biomarkers correlate well with Doppler surrogate markers of vascular toxicity, larger studies to refine prediction models could be undertaken. This would be a step forward personalized care for the prediction of major cardiovascular events on ICIs.

Enrollment: 40 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• All patients scheduled for first ICI therapy at our institution;
• Matched controls with cancer and no ICI therapy;

Exclusion criteria

• Major cardiovascular event in the past 6 months;
• Unable to provide informed consent;
• History of ICI therapy

Trial design

Primary purpose: Basic Science

Allocation: Non-Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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40 participants in 4 patient groups

ICIs alone

Experimental group

Description:

Participants on ICIs alone

Treatment:

Diagnostic Test: Arterial Doppler for Flow Mediated Reserve measurement

ICIs + VEGF inhibitors

Experimental group

Description:

Participants on ICIs + VEGF inhibitors

Treatment:

Diagnostic Test: Arterial Doppler for Flow Mediated Reserve measurement

ICIs + chemotherapy

Experimental group

Description:

Participants on ICIs + chemotherapy

Treatment:

Diagnostic Test: Arterial Doppler for Flow Mediated Reserve measurement

Controls

Sham Comparator group

Description:

Participants on other than ICIs cancer therapies

Treatment:

Diagnostic Test: Arterial Doppler for Flow Mediated Reserve measurement