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.
Highlights
Due to earlier detection and highly effective multi-modality treatments, cancer has become a largely curable disease and a chronic illness
The purpose of this review is to provide a comprehensive assessment of the evidence on cardiac troponins and natriuretic peptides as biomarkers of cardiac toxicity
Of those that try to isolate the effect of radiotherapy, none have been able draw clinically valuable conclusions regarding the value of troponin in predicting radiation-induced cardiotoxicity [64, 72, 82]
Summary
Due to earlier detection and highly effective multi-modality treatments, cancer has become a largely curable disease and a chronic illness. Cardiac troponins have consistently demonstrated clinical value in predicting subsequent cardiotoxicity after high-dose chemotherapy (HDC), irrespective of cancer type This result is based on four major experiences that enrolled approximately 200–700 patients each (Table 1) [60,61,62,63]. Cardinale et al provided the earliest evidence cardiac troponin values can stratify patients on risk of developing trastuzumab-induced cardiotoxicity, based on 251 breast cancer patients who were followed for a median of 14 months after completion of trastuzumab treatment [75]. Troponin positivity predicted LVEF recovery with a PPV of 65% and NPV of 100% This suggested that negative TnI measurements during treatment can be used to assign a lower risk status to select patients who are less likely to benefit from cardiac screening at routine intervals. Using an ultrasensitive troponin assay that established 30 pg/ml www.frontiersin.org
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