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Telli RC. Trial architecture in contemporary cardio-oncology: Why parallel-group randomized controlled trials may not fit every cardiotoxicity phenotype. World J Cardiol 2026; 18(11): 126635 [DOI: 10.4330/wjc.126635]
World J Cardiol. Nov 26, 2026; 18(11): 126635 Published online Nov 26, 2026. doi: 10.4330/wjc.126635
Trial architecture in contemporary cardio-oncology: Why parallel-group randomized controlled trials may not fit every cardiotoxicity phenotype
Radhia Chems Telli
Radhia Chems Telli, Department of Medicine, University of Biskra, Biskra 07000, Algeria
Radhia Chems Telli, Faculty of Medicine, Université Salah Boubnider Constantine 3, Constantine 25000, Algeria
Author contributions: Telli RC wrote the main text of the manuscript, read and approved the final version of the manuscript to be published.
AI contribution statement: Generative AI tools were used in this work. Gemini (standard version; Google) was used on August 7, 2026 to create the layout of Figure 1. Consensus, an AI-assisted search tool, was used between August 5, 2026 and August 8, 2026 to narrow the set of candidate papers. ChatGPT (OpenAI) was used to check compliance with the journal’s author guidelines and submission requirements. AI tools were not used to interpret data or draw conclusions. The author was responsible for the content of the manuscript.
Conflict-of-interest statement: The author declares no conflict of interest in publishing the manuscript.
Corresponding author: Radhia Chems Telli, Researcher, Department of Medicine, University of Biskra, B.P. 145, RP, Biskra 07000, Algeria. radhia.telli@univ-biskra.dz
Received: August 10, 2026 Revised: October 1, 2026 Accepted: October 28, 2026 Published online: November 26, 2026 Processing time: 97 Days and 21.1 Hours
Core Tip
Core Tip: This minireview is concerned with how cardioprotection trials are designed, not with the pharmacological efficacy of any particular cardioprotective agent. These trials have relied almost exclusively on the conventional parallel-group randomized controlled trial, regardless of which cardiotoxicity phenotype is studied. This minireview maps six contemporary phenotypes – from anthracycline-related left ventricular dysfunction to radiation-induced cardiovascular disease – against established trial-design principles (biomarker-enriched, adaptive, master-protocol, and registry-embedded designs) already used elsewhere in medicine. Only anthracycline-related left ventricular dysfunction is currently supported by conducted trials using an alternative architecture; the remaining five phenotypes require prospective evaluation of untested conceptual directions.
