Serum Biomarkers for the Detection of Cardiac Toxicity after Chemotherapy and Radiation Therapy in Breast Cancer Patients

Abstract

Multi-modality cancer treatments that include chemotherapy, radiation therapy, and targeted agents are highly effective therapies. Their use, especially in combination, is limited by the risk of significant cardiac toxicity. The current paradigm for minimizing cardiac morbidity, based on serial cardiac function monitoring, is suboptimal. An alternative approach based on biomarker testing, has emerged as a promising adjunct and a potential substitute to routine echocardiography. Biomarkers, most prominently cardiac troponins and natriuretic peptides, have been evaluated for their ability to describe the risk of potential cardiac dysfunction in clinically asymptomatic patients. Early rises in cardiac troponin concentrations have consistently predicted the risk and severity of significant cardiac events in patients treated with anthracycline-based chemotherapy. Biomarkers represent a novel, efficient, and robust clinical decision tool for the management of cancer therapy-induced cardiotoxicity. This article aims to review the clinical evidence that supports the use of established biomarkers such as cardiac troponins and natriuretic peptides, as well as emerging data on proposed biomarkers.

Cardiologic evaluation of patients undergoing chemoterapy

“…Alterati valori di BNP e NT-proBNP sono stati osservati in corso di trattamento con diversi chemioterapici (doxorubuicina, trastuzumab, epirubicina) e di radioterapia, risultato che esprime lo stress di parete a carico del ventricolo sinistro durante il trattamento. Nonostante ciò, i risultati emersi dai numerosi studi condotti, sia nella popolazione adulta che pediatrica, hanno prodotto risultati discordanti e pertanto l'utilizzo routinario di tali biomarcatori non risulta raccomandato e non può sostituire l'utilizzo di metodiche di imaging quali l'ecocardiogramma [16].…”

The use of biomarkers in detecting subclinical cardiotoxicity in doxorubicin-based treatment for paediatric patients with acute lymphoblastic leukaemia

“…AC-induced cardiac injury is dose dependent and the international recommendations are not to exceed 450-550 mg/m² [3], although even lower doses have led to cardiac damage in certain patients [4]. The gold standard for cardiotoxicity detection is serial echocardiography, used prior to treatment initiation and during the course of chemotherapy [5].…”

“…The gold standard for cardiotoxicity detection is serial echocardiography, used prior to treatment initiation and during the course of chemotherapy [5]. Cardiac biomarkers (troponin T, troponin I (TnI), natriuretic peptides, high-sensitivity C reactive protein, glycogen phosphorylase isoenzyme BB, heart-type fatty acid binding protein (H-FABP), myeloperoxidase, total antioxidant status, circulating microRNAs, creatinine kinase) represent an attractive alternative for the detection of cardiotoxicity and are intensively analysed for many advantages such as being operator-independent, non-invasive and a resource-efficient approach [4].…”

Determination of early tumoricidal drug-induced cardiotoxicity with biological markers

“…Additionally, there are no developed clinical guidelines for early detection of cardiotoxicity too. It has been suggested that biomarkers, most prominently brain natriuretic peptides (BNPs), cardiac troponins, inflammatory biomarkers (C-reactive protein, soluble ST, galectin-3) and signature microRNAs might have utility to stratify the patients at risk of potential cardiac dysfunction at early stage before clinical manifestation [10,11]. The aim of the mini review is consideration the clinical evidence that supports the use of cardiac biomarkers for early detection of cardiotoxicity.…”