Improving cardiotoxicity prediction in cancer treatment: integration of conventional circulating biomarkers and novel exploratory tools

Pang, Li; Liu, Zhichao; Feng, Wei; Cai, Chengzhong; Yang, Xi

doi:10.1007/s00204-020-02952-7

Cited by 7 publications

(4 citation statements)

References 94 publications

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“…ASCO recommends that physicians promptly monitor for cardiotoxicity and assess baseline cardiac risk factors in this highrisk population [45]. Serum biomarkers [46][47][48], echocardiography [49][50][51], advanced cardiovascular imaging [52,53], and artificial intelligence-assisted diagosis [54,55] facilitate early identification of cardiovascular toxicity associated with cancer therapy. Efforts should be made to improve the oncologists' and patients' awareness of cancer treatment-related cardiotoxicity, further explore personalized treatment options, and combine the above tools for early screening and follow-up of cardiotoxicity.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a nomogram to predict cardiac death after radiotherapy for esophageal cancer

Lv,

Wu,

Liu

et al. 2023

Cancer Innovation

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BackgroundPatients frequently die from cardiac causes after radiotherapy for esophageal cancer. Early detection of cardiac death risk in these patients is crucial to improve clinical decision‐making and prognosis. Thus, we modeled the risk of cardiac death after irradiation for esophageal cancer.MethodsA retrospective analysis of 37,599 esophageal cancer cases treated with radiotherapy in the SEER database between 2000 and 2018 was performed. The selected cases were randomly assigned to the model development group (n = 26,320) and model validation group (n = 11,279) at a ratio of 7:3. We identified the risk factors most commonly associated with cardiac death by least absolute shrinkage and selection operator regression analysis (LASSO). The endpoints for model development and validation were 5‐ and 10‐year survival rates. The net clinical benefit of the models was evaluated by decision curve analysis (DCA) and concordance index (C‐index). The performance of the models was further assessed by creating a receiver operating characteristic curve (ROC) and calculating the area under the curve (AUC). Kaplan‐Meier (K‐M) survival analysis was performed on the probability of death. Patients were classified according to death probability thresholds. Five‐ and ten‐year survival rates for the two groups were shown using K‐M curves.ResultsThe major risk factors for cardiac death were age, surgery, year of diagnosis, sequence of surgery and radiotherapy, chemotherapy and a number of tumors, which were used to create the nomogram. The C‐indexes of the nomograms were 0.708 and 0.679 for the development and validation groups, respectively. DCA showed the good net clinical benefit of nomograms in predicting 5‐ and 10‐year risk of cardiac death. The model exhibited moderate predictive power for 5‐ and 10‐year cardiac mortality (AUC: 0.833 and 0.854, respectively), and for the development and validation cohorts (AUC: 0.76 and 0.813, respectively).ConclusionsOur nomogram may assist clinicians in making clinical decisions about patients undergoing radiotherapy for esophageal cancer based on early detection of cardiac death risk.

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Section: Discussionmentioning

confidence: 99%

Development and validation of a nomogram to predict cardiac death after radiotherapy for esophageal cancer

Lv,

Wu,

Liu

et al. 2023

Cancer Innovation

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“…Beyond these conventional cardiac markers, there are several emerging biomarkers of RICVD under investigation. Emerging “omics” (e.g., genomics, metabolomics) tools hold potential for identifying new RICVD biomarkers, as alterations in nucleic acids and cellular metabolism are among the first to occur with radiation deposition [ 102 , 103 ]. Other emerging biomarkers being applied to RICVD surveillance include lipopolysaccharide binding protein, which has been found to positively correlate with cardiac dose and post-RT diastolic function, gal-3, and pro-inflammatory cytokines (TNF-a, IL-1, IL-6) [ 71 , 103 – 105 ].…”

Section: Radiation-induced Cardiovascular Diseasementioning

confidence: 99%

“…Emerging “omics” (e.g., genomics, metabolomics) tools hold potential for identifying new RICVD biomarkers, as alterations in nucleic acids and cellular metabolism are among the first to occur with radiation deposition [ 102 , 103 ]. Other emerging biomarkers being applied to RICVD surveillance include lipopolysaccharide binding protein, which has been found to positively correlate with cardiac dose and post-RT diastolic function, gal-3, and pro-inflammatory cytokines (TNF-a, IL-1, IL-6) [ 71 , 103 – 105 ]. Increased ST2 levels following adjuvant radiotherapy in chemo-naïve breast cancer patients have also correlated to worsening GLS; however, clinical outcomes are unknown [ 106 ].…”

Section: Radiation-induced Cardiovascular Diseasementioning

confidence: 99%

Recent Advances in Serum Biomarkers for Risk Stratification and Patient Management in Cardio-Oncology

et al. 2023

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Purpose of Review Following significant advancements in cancer therapeutics and survival, the risk of cancer therapy-related cardiotoxicity (CTRC) is increasingly recognized. With ongoing efforts to reduce cardiovascular morbidity and mortality in cancer patients and survivors, cardiac biomarkers have been studied for both risk stratification and monitoring during and after therapy to detect subclinical disease. This article will review the utility for biomarker use throughout the cancer care continuum. Recent Findings A recent meta-analysis shows utility for troponin in monitoring patients at risk for CTRC during cancer therapy. The role for natriuretic peptides is less clear but may be useful in patients receiving proteasome inhibitors. Early studies explore use of myeloperoxidase, growth differentiation factor 15, galectin 3, micro-RNA, and others as novel biomarkers in CTRC. Summary Biomarkers have potential to identify subclinical CTRC and may reveal opportunities for early intervention. Further research is needed to elucidate optimal biomarkers and surveillance strategies.

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“…Future studies can be improved in the following ways: (1) a longer follow-up time will provide valuable data for improve the predictive power of biomarkers for late cardiotoxicity; (2) increasing the sample size will improve study accuracy; (3) the direction of cardiotoxicity caused by targeted therapy or ICIs should be further explored. Genetic testing, human stem cell-derived cardiomyocytes and artificial intelligence have all been used to predict subclinical CTRCD ( 122 ).…”

Section: Conclusion and Prospectmentioning

confidence: 99%

Advances in Biomarkers for Detecting Early Cancer Treatment-Related Cardiac Dysfunction

Xiao

Wang

et al. 2021

Front. Cardiovasc. Med.

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With the gradual prolongation of the overall survival of cancer patients, the cardiovascular toxicity associated with oncology drug therapy and radiotherapy has attracted increasing attention. At present, the main methods to identify early cancer treatment-related cardiac dysfunction (CTRCD) include imaging examination and blood biomarkers. In this review, we will summarize the research progress of subclinical CTRCD-related blood biomarkers in detail. At present, common tumor therapies that cause CTRCD include: (1) Chemotherapy—The CTRCD induced by chemotherapy drugs represented by anthracycline showed a dose-dependent characteristic and most of the myocardial damage is irreversible. (2) Targeted therapy—Cardiovascular injury caused by molecular-targeted therapy drugs such as trastuzumab can be partially or completely alleviated via timely intervention. (3) Immunotherapy—Patients developed severe left ventricular dysfunction who received immune checkpoint inhibitors have been reported. (4) Radiotherapy—CTRCD induced by radiotherapy has been shown to be significantly associated with cardiac radiation dose and radiation volume. Numerous reports have shown that elevated troponin and B-type natriuretic peptide after cancer treatment are significantly associated with heart failure and asymptomatic left ventricular dysfunction. In recent years, a few emerging subclinical CTRCD potential biomarkers have attracted attention. C-reactive protein and ST2 have been shown to be associated with CTRCD after chemotherapy and radiation. Galectin-3, myeloperoxidas, placental growth factor, growth differentiation factor 15 and microRNAs have potential value in predicting CTRCD. In this review, we will summarize CTRCD caused by various tumor therapies from the perspective of cardio-oncology, and focus on the latest research progress of subclinical CTRCD biomarkers.

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Improving cardiotoxicity prediction in cancer treatment: integration of conventional circulating biomarkers and novel exploratory tools

Cited by 7 publications

References 94 publications

Development and validation of a nomogram to predict cardiac death after radiotherapy for esophageal cancer

Development and validation of a nomogram to predict cardiac death after radiotherapy for esophageal cancer

Recent Advances in Serum Biomarkers for Risk Stratification and Patient Management in Cardio-Oncology

Advances in Biomarkers for Detecting Early Cancer Treatment-Related Cardiac Dysfunction

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