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Phase I/II Study of EP-guided Noninvasive Cardiac Radioablation for Treatment of Ventricular Tachycardia (ENCORE-VT)

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ClinicalTrials.gov Identifier: NCT02919618
Recruitment Status : Active, not recruiting
First Posted : September 29, 2016
Last Update Posted : January 8, 2018
Sponsor:
Information provided by (Responsible Party):
Phillip Cuculich, Washington University School of Medicine

Brief Summary:
Phase I/II Study of EP-guided Noninvasive Cardiac Radioablation (ENCORE) for Treatment of Ventricular Tachycardia

Condition or disease Intervention/treatment Phase
Ventricular Tachycardia Cardiomyopathy Premature Ventricular Contractions Radiation: stereotactic body radiotherapy (SBRT) Phase 1 Phase 2

Detailed Description:
Patients with Ventricular Tachycardia (VT) who have failed standard therapy (medicines, invasive catheter ablation) have limited options, with one-year survival below 20%. Preclinical data demonstrate that single fraction stereotactic body radiotherapy (SBRT) to discrete portions of the heart is feasible and may result in a reduction or elimination of VT. The efficacy may be further improved when guided by cardiac electrophysiologic (EP) testing. In total, the mapping and ablation proposed for this EP-guided Noninvasive Cardiac Radioablation (ENCORE) is a rapid and totally non-invasive method. Overall safety and early efficacy of ENCORE have not been rigorously studied in a prospective trial to-date. The purpose of this phase I/II study is to demonstrate the short-term safety and preliminary efficacy of ENCORE for patients with life-threatening, treatment-refractory VT.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 20 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase I/II Study of EP-guided Noninvasive Cardiac Radioablation for Treatment of Ventricular Tachycardia
Actual Study Start Date : July 2016
Estimated Primary Completion Date : May 2018
Estimated Study Completion Date : January 2019

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: stereotactic body radiotherapy (SBRT)
Noninvasive SBRT will be delivered in a single fraction to a region of the heart determined by EP-guidance, using noninvasive electrical mapping combined with anatomic imaging.
Radiation: stereotactic body radiotherapy (SBRT)
(Cardiac ablative radiotherapy)




Primary Outcome Measures :
  1. Acute (≤ 90 days) safety of noninvasive stereotactic cardiac ablation radiotherapy (ENCORE). [ Time Frame: < or = 90 days ]
    Demonstrate acute (≤ 90 days) safety of noninvasive stereotactic cardiac ablation radiotherapy (ENCORE). The primary safety endpoint is defined by a ≤ 20% rate of serious adverse events (SAEs) using CTCAE v4.0 criteria that are possibly/probably/definitely related to study treatment, based on previously published data for expected invasive catheter-based VT-ablation procedures.

  2. Efficacy of ENCORE [ Time Frame: 12 months ]
    Primary efficacy endpoint is defined by the number of subjects with a reduction in VT burden comparing the period six months before ENCORE treatment to the six months after ENCORE treatment as adjudicated by continuous ICD monitoring (number of ATP and ICD shocks and sustained (>30 second) nontreated slow VT). There will be a six-week "blanking period" after therapy to allow for ablation effect. For patients with PVC-induced cardiomyopathy, the primary efficacy will be any reduction in PVC burden based on ambulatory heart monitors.


Secondary Outcome Measures :
  1. Overall mortality [ Time Frame: 12 months ]
    Determine six-month and twelve-month survival (overall mortality endpoint) after treatment with ENCORE.

  2. Late toxicity [ Time Frame: 90 days to 12 months ]
    Toxicities that occur after treatment, but are not acutely ascribed to treatment

  3. Health related quality of life (HRQOL) [ Time Frame: 6 week, 6 month, 12 month ]
    Assessing for positive or negative changes in quality of life related to treatment and its results based on scores from standardized SF-36 questionnaire

  4. Stricter efficacy (50% reduction) [ Time Frame: 6 months ]
    Evaluate stricter efficacy endpoint of ENCORE treatment, as defined by number of patients who have had 50% reduction in any VT therapies (ATP or ICD shocks or sustained (>30sec) nontreated slow VT) after ENCORE treatment (6 months before vs. 6 months after treatment, with a 6 week blanking period immediately after treatment). For patients with PVC-induced cardiomyopathy, the stricter efficacy will be >50% reduction in PVC burden based on ambulatory heart monitors.

  5. Strictest efficacy (95% reduction) [ Time Frame: 6 months ]
    Evaluate strictest efficacy endpoint of ENCORE treatment, as defined by number of patients who have had 95% reduction in any VT (ATP or ICD shocks or sustained (>30 sec) slow VT) after ENCORE treatment (6 months before vs. 6 months after treatment, with a 6 week blanking period immediately after treatment). For patients with PVC-induced cardiomyopathy, the strictest efficacy will be abolition of PVC burden (<1%) based on ambulatory heart monitors.

  6. Most clinically useful efficacy (ICD shocks & LVEF improvement) [ Time Frame: 6 months ]
    Evaluate the most clinically useful efficacy endpoint of ENCORE treatment, namely, number of patients with reduction specifically in ICD shocks (6 months before vs. 6 months after treatment, with a 6 week blanking period immediately after treatment). For patients with PVC-induced cardiomyopathy, the most clinically useful efficacy will be improvement in cardiac function in the setting of any improvement in PVC burden.

  7. Longer-term durability (6 to 12 month period) [ Time Frame: 12 months ]
    Evaluate longer-term durability endpoint of ENCORE treatment, as defined by number of patients with reduction in VT therapies (ATP or ICD shock or sustained (>30 sec) slow VT and ICD shock alone) during the early phase (treatment to 6 months, with 6 week blanking period) vs. the late phase (6 months to 1 year). For patients with PVC-induced cardiomyopathy, the longer-term durability efficacy will be persistence of any reduction in PVC burden based on ambulatory heart monitors during early phase vs. late phase.



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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. DOCUMENTED VT:

    1. Patient must have documented sustained monomorphic ventricular tachycardia as documented on either a 12-lead ECG or intracardiac ICD interrogation — OR—
    2. Monomorphic PVCs documented on a 12-lead ECG.
  2. ANTIARRHYTHMIC MEDICATION: Patient must have failed or become intolerant to at least one antiarrhythmic medication (amiodarone, sotalol, or mexiletine).

    -AND—

  3. CATHETER ABLATION: Patient must have failed at least one invasive catheter ablation procedure, or have a contraindication to a catheter ablation procedure (e.g., LV thrombus, severe pulmonary disease), or have VT thought to arise from a protected location (e.g., epicardial VT with history of previous cardiac surgery).
  4. MINIMUM VT BURDEN: Patient must have either:

    1. At least 3 VT episodes (sustained VT, ICD ATP or ICD shock) over previous 6 months prior to enrollment

      -OR—

    2. >20% PVC burden with a cardiomyopathy (LVEF<50%)
  5. Patient must be deemed medically fit for stereotactic body radiation therapy by the treating physician.
  6. Patient must be > 18 years old.
  7. Patient must be able to understand and be willing to sign an IRB approved written informed consent document.

Exclusion Criteria:

  1. Patient must not have past history of radiotherapy within the projected treatment field.
  2. Advanced symptomatic heart failure as defined as NYHA Class IV heart failure (inotrope dependent and/or current left-ventricular assist device (LVAD))
  3. Polymorphic VT or ventricular fibrillation (VF) as a clinical heart rhythm (as determined by 12-lead ECG and/or ICD interrogation).
  4. More than 3 distinct clinical VT morphologies observed (ECG or ICD interrogation or invasive EP study) OR more than 5 distinct induced VT morphologies during ECGI testing.
  5. Advanced myocardial scar substrate that would require stereotactic delivery to a target volume deemed unsafe by the treating physician.
  6. Unlikely to live 12 months, in the absence of VT, as best based on clinical judgment by the treating and enrolling physicians.
  7. Patient must not be pregnant and/or breastfeeding and must have a negative pregnancy test within 14 days of study entry.


Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02919618


Locations
United States, Missouri
Washington University School of Medicine
Saint Louis, Missouri, United States, 63110
Sponsors and Collaborators
Washington University School of Medicine
Investigators
Principal Investigator: Phillip Cuculich, MD Washington University School of Medicine

Responsible Party: Phillip Cuculich, M.D., Washington University School of Medicine
ClinicalTrials.gov Identifier: NCT02919618     History of Changes
Other Study ID Numbers: 201606081
First Posted: September 29, 2016    Key Record Dates
Last Update Posted: January 8, 2018
Last Verified: January 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description: Open sharing at the time of publication of results

Keywords provided by Phillip Cuculich, Washington University School of Medicine:
Ventricular Tachycardia
Ablation
Noninvasive

Additional relevant MeSH terms:
Cardiomyopathies
Tachycardia
Tachycardia, Ventricular
Ventricular Premature Complexes
Heart Diseases
Cardiovascular Diseases
Arrhythmias, Cardiac
Pathologic Processes
Cardiac Complexes, Premature