Trial Information

Pilot Study of Statin Therapy in Young Adult Survivors of Childhood Cancer

Adult survivors of childhood cancer are at seven times the risk of dying from cardiovascular
disease compared to the general population. The increased risk is thought to be the result
of the therapies used to treat the cancer such as chemotherapy and radiation. These
therapies likely cause damage to the endothelial cells, which line the arterial wall and,
when function properly, offer protection from atherosclerosis. Young adult survivors of
childhood ALL have reduced endothelial function, or endothelial dysfunction, compared to
healthy controls. Endothelial dysfunction is considered an early manifestation of
atherosclerosis and therefore is an ideal target of therapy in order to reduce the risk of
cardiovascular disease. Interventions that improve endothelial function in young adult
survivors of childhood cancer may be beneficial in terms of mitigating the medium- and
long-term risk of developing this chronic disease.

HMG coenzyme A reductase inhibitors, or statins, are widely used for cardiovascular disease
risk reduction. These medications are primarily used to reduce levels of total- and
low-density lipoprotein (LDL) -cholesterol. Meta-analyses have consistently demonstrated
that statin therapy improves endothelial function in a wide array of patient populations.
Beyond their well-described vascular benefits, statins are an attractive therapeutic option
for cardiovascular disease risk reduction due to their strong safety profile.

Despite the clear potential for endothelial function improvement and cardiovascular risk
reduction, statin therapy has never been evaluated in survivors of childhood cancer.
Although statins have been well-studied in other patient populations at risk for
cardiovascular disease, there is strong justification for evaluation in cancer survivors
since the mechanisms responsible for the vascular problems in these individuals
(treatment-induced vascular toxicity) differ from traditional atherosclerosis. Therefore,
the objective of the current study is to assess the ability of statin therapy to improve
endothelial function, arterial stiffness, and arterial thickening in young adult survivors
of childhood cancer. The focus of the study will be on survivors of hematologic
malignancies, acute lymphoblastic leukemia (ALL) and non-Hodgkin's lymphoma (NHL), since the
former has been shown to be associated with endothelial impairments and both cancers share
common treatment exposures (chemotherapy and radiation), which is likely the primary factor
responsible for endothelial dysfunction in these individuals.

Twenty-four young adult (age 18-39 years old) survivors of childhood acute lymphoblastic
leukemia (ALL) and non-Hodgkin's lymphoma (NHL)will be enrolled in a six-month randomized,
double-blind (participants and investigators), placebo-controlled pilot clinical trial
comparing the effects of atorvastatin versus placebo on endothelial function and other
measures of vascular health. Following baseline testing, subjects will be randomly assigned
(1:1) to either atorvastatin or placebo. Participants will return at 1-month and 3-months
for assessment of safety (blood draw and adverse event assessment) and medication compliance
and at 6-months for assessment of safety, medication compliance, and reassessment of
baseline variables.