Anthracycline-induced cardiotoxicity: A multicenter randomised trial comparing two strategies for guiding prevention with enalapril: The International CardioOncology Society-one trial

Cardinale, Daniela; Latini, Roberto; Civelli, Maurizio; Curigliano, Giuseppe; Salvatici, Michela; Staszewsky, Lidia; Barlera, Simona; Nicolis, Enrico; Magnoli, Michela; Cipolla, Carlo M.; Ciceri, Fabio; Sandri, Maria Teresa; Maggioni, Aldo P.; Labianca, Roberto; Tettamanti, Mauro; Senni, Michele; Finzi, A; Grosso, Federica; Vago, Tarcisio; Gramenzi, Silvana; Masson, Serge; Balconi, Giovanna; Bernasconi, Roberto; Buratti, M.G.; Fernandez, Maria Luisa Ojeda; Franzosi, Maria Grazia; Vasamì, Antonella; Malossi, Alessandra; Sicuro, Marco; Thiebat, B.; Bare, Catherine V.; Corzani, Alessandro; Coccolo, Fabio; Colecchia, S.; Pellegrini, Carlo; Bregni, Marco; Appio, L.; Caico, I.; Rossetti, G.; Mesenzani, O.; Campana, Camila Sato; Giordano, Monica; Gilardoni, Mónica Beatriz; Scognamiglio, Giancarlo; Corrado, Giovanni; Battagin, D.; Rosa, Fabrizio De; Carpino, C.; Palazzo, Salvatore; Monopoli, Anna; Milandri, Carlo; Giannessi, P. G.; Zipoli, G.; Ghisoni, Francesco; Rizzo, A; Pastori, Paolo; Callegari, Simona; Sesenna, C.; Colombo, Alessandro; Fodor, C.; Mangiavacchi, Maurizio; Cavina, Raffaele; Guiducci, Daniela; Mazza, Rita; Turazza, F.; Vallerio, Paola; Marbello, Laura; Sala, Emanuela; Fragasso, Gabriele; Trinca, Stefania; Aquilina, Michele; Rocca, Andrea; Farolfi, Alberto; Andreis, Daniele; Gori, Stefania; Barbieri, Enrico; Lanzoni, Laura; Marchetti, Floriano; Falci, Cristina; Bianchi, Alessandra; Mioranza, Eleonora; Banzato, Alberto; Re, Francesca; Gaibazzi, Nicola; Gullo, Matthew J.; Turina, M.; Gervasi, Erika; Giaroli, Federica; Nassiacos, Daniele; Verusio, Claudio; Barco, B; Bertolini, A.; Cucchi, G; Menatti, E.; Sinagra, G.; Aleksova, Aneta; Guglielmi, Alfredo; Pinotti, Graziella; Gueli, Rossana; Mongiardi, C.; Vallini, I.

doi:10.1016/j.ejca.2018.02.005

Cited by 185 publications

(178 citation statements)

References 32 publications

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“…Recent randomized trials have assessed whether β‐blocker or ACE inhibitor therapy prevents heart failure in patients receiving cardiotoxic therapy . A benefit in troponin‐guided identification of high‐risk patients to receive cardioprotective ACE inhibitor therapy was initially found but could not be recapitulated in a multicentre randomized trial . In anthracycline‐treated patients, β‐blocker or ACE inhibitor therapy was associated with a lower frequency of troponin elevation in treatment groups compared to control/placebo indicating a potential role of biomarkers as a marker for response to therapy but a correlation between biomarker response and preservation of LV function has not yet been demonstrated.…”

Section: Discussionmentioning

confidence: 99%

Troponins and brain natriuretic peptides for the prediction of cardiotoxicity in cancer patients: a meta‐analysis

Michel

Mincu

Mahabadi

et al. 2019

European J of Heart Fail

189

154

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Aims Cardiac biomarkers are a mainstay in diagnosis of cardiovascular disease but their role in cardio‐oncology has not yet been systematically evaluated. This meta‐analysis aims to determine whether cardiac troponins and (N‐terminal pro) brain natriuretic peptide (BNP/NT‐proBNP) predict cancer therapy‐related left ventricular (LV) dysfunction. Methods and results Scientific databases were searched for studies that assessed troponins or BNP/NT‐proBNP in adult patients undergoing cancer therapy. Data from 61 trials with 5691 patients were included. Cancer therapy was associated with an increase in troponin levels [odds ratio (OR) 14.3, 95% confidence interval (CI) 6.0–34.1; n = 3049]. Patients with elevated troponins receiving chemotherapy or human epidermal growth factor receptor 2 inhibitor therapy were at higher risk for LV dysfunction (OR 11.9, 95% CI 4.4–32.1; n = 2163). Troponin had a negative predictive value of 93%. Mean BNP/NT‐proBNP levels were increased in patients post‐treatment (standardized mean difference 0.6, 95% CI 0.3–0.9; n = 912), but the available evidence did not consistently indicate prediction of LV dysfunction (OR 1.7, 95% CI 0.7–4.2; n = 197). β‐blocker and angiotensin‐converting enzyme inhibitor therapy to mitigate cardiotoxicity during cancer therapy was associated with a decline in serum troponins (OR 4.1, 95% CI 1.7–9.8; n = 466). Conclusion Elevated troponin levels predict LV dysfunction in patients receiving cancer therapy. Assessment of troponin levels may qualify as a screening test to identify patients who require referral to cardio‐oncology units and benefit from preventive strategies. Further evidence is required for both biomarkers.

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Section: Discussionmentioning

confidence: 99%

Troponins and brain natriuretic peptides for the prediction of cardiotoxicity in cancer patients: a meta‐analysis

Michel

Mincu

Mahabadi

et al. 2019

European J of Heart Fail

189

154

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“…Angiotensin inhibitors and receptor blockers A few trials have evaluated an ARB or an ACEI for preventing anthracycline-associated cardiac dysfunction. The multicenter phase III ICOS-ONE (International CardioOncology Society-ONE) trial compared patients randomly assigned to receive enalapril at the start of chemotherapy (the prevention group) with those in whom enalapril was started only after serum troponin concentrations increased (the troponin-triggered group) [93]. The incidence of troponin elevations peaked 1 month after chemotherapy and was similar in both groups: 26% (31/ 136) in the prevention and 23% (36/137) in the troponin-triggered group.…”

Section: Clinical Studies In Adultsmentioning

confidence: 99%

Strategies to prevent anthracycline-induced cardiotoxicity in cancer survivors

et al. 2019

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Cancer diagnostics and therapies have improved steadily over the last few decades, markedly increasing life expectancy for patients at all ages. However, conventional and newer anti-neoplastic therapies can cause short-and long-term cardiotoxicity. The clinical implications of this cardiotoxicity become more important with the increasing use of cardiotoxic drugs. The implications are especially serious among patients predisposed to adverse cardiac effects, such as youth, the elderly, those with cardiovascular comorbidities, and those receiving additional chemotherapies or thoracic radiation. However, the optimal strategy for preventing and managing chemotherapyinduced cardiotoxicity remains unknown. The routine use of neurohormonal antagonists for cardioprotection is not currently justified, given the marginal benefits and associated adverse events, particularly with long-term use. The only United States Food and Drug Administration and European Medicines Agency approved treatment for preventing anthracycline-related cardiomyopathy is dexrazoxane. We advocate administering dexrazoxane during cancer treatment to limit the cardiotoxic effects of anthracycline chemotherapy.

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“…Therefore, it remains challenging to identify patients who will benefit from such treatments. Several studies have explored if elevations in CV biomarkers, most notably natriuretic peptides (NPs) and cardiac troponins (cTn) could be used to guide CV treatments . However, these studies had small sample size and heterogeneous populations.…”

mentioning

confidence: 99%

“…Several studies have explored if elevations in CV biomarkers, most notably natriuretic peptides (NPs) and cardiac troponins (cTn) could be used to guide CV treatments. [4][5][6][7] However, these studies had small sample size and heterogeneous populations. At current, there is no consensus on the use of biomarkers and CV treatments in patients with cancer.…”

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confidence: 99%

Troponins and natriuretic peptides to detect cardiotoxicity: useful biomarkers or paradise lost?

Bračun

Boer

2020

European J of Heart Fail

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Anthracycline-induced cardiotoxicity: A multicenter randomised trial comparing two strategies for guiding prevention with enalapril: The International CardioOncology Society-one trial

Cited by 185 publications

References 32 publications

Troponins and brain natriuretic peptides for the prediction of cardiotoxicity in cancer patients: a meta‐analysis

Troponins and brain natriuretic peptides for the prediction of cardiotoxicity in cancer patients: a meta‐analysis

Strategies to prevent anthracycline-induced cardiotoxicity in cancer survivors

Troponins and natriuretic peptides to detect cardiotoxicity: useful biomarkers or paradise lost?

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