Cardiac Biomarkers in Patients with Cancer: Considerations, Clinical Implications, and Future Avenues

Abstract

Purpose of the Review As the number of cancer survivors increases due to early screening and modern (antineoplastic) treatments, cancer treatment associated cardiotoxicity (CTAC) is becoming an increasing health burden that affects survival and quality of life among cancer survivors. Thus, clinicians need to identify adverse events early, in an effort to take suitable measures before the occurrence of permanent or irreversible cardiac dysfunction. Recent Findings Cardiac troponin (cTn) and B-type natriuretic peptide (BNP) have been proven to detect subclinical cardiotoxicity during antineoplastic treatment. As such, these cardio-specific biomarkers could predict which patients are at risk of developing CTAC even before the start of therapy. Nevertheless, there are inconsistent data from published studies, and the recommendations regarding the use of these biomarkers and their validity are mostly based on expert consensus opinion. Summary In this review, we summarize available literature that evaluates biomarkers of CTAC, and we encourage strategies that integrate circulating biomarkers and cardiac imaging in identifying cancer patients that are at high risk.

Common mechanistic pathways in cancer and heart failure. A scientific roadmap on behalf of the Translational Research Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

“…Specific studies focusing on HF-cancer interactions would be needed to answer important unsolved questions such as defining the characteristics of patients who are more susceptible to present both conditions, identifying some early and specific predictive biomarkers, [130][131][132][133][134][135][136][137] adequately adjusting the management of those patients, and better understanding of shared mechanisms that could lead to target common regulators of HF and cancer. To answer these questions, dedicated registries and studies would need to reach three main requirements.…”

A new classification of cardio-oncology syndromes

“…Modern cancer therapies can lead to CV structural and functional dysfunction [ 21 ]. Cardiotoxicity is one of the most concerning side effects of chemotherapy.…”

Enhancing Pharmacovigilance from the US Experience: Current Practices and Future Opportunities

“…Cardiovascular safety studies have been performed across a variety of therapeutic areas, e.g., arthritis, coronary artery disease, diabetes, obesity, and pulmonary disease. The Cardiac Safety Research Consortium, which supports research by engaging stakeholders from the pharmaceutical industry, academia, and government to collaborate and share data and expertise, is a public private partnership that was formed in 2016 [ 17 ]. This consortium acts as a think tank and shares work with electrocardiogram data, as well as other areas of cardiac safety evaluation from the preclinical, through to the post-marketing setting.…”

“…Both cardiac troponin and B-type natriuretic peptide have been shown to detect subclinical cardiotoxicity during cancer treatment. Monitoring these cardio-specific biomarkers should be strongly considered and could predict which patients are at risk of developing cardiotoxicities even before the start of therapy [ 17 ].…”