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March 15, 2021Open Science JournalOpen Access

The role of cardiac biomarkers in early detection of cardiotoxicity in breast cancer treated with trastuzumab in the adjuvant setting: a systematic review

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Key result

NT-proBNP was not predictive of trastuzumab-induced cardiotoxicity, whereas troponins I and T showed a predictive role for early detection in patients with early-stage breast cancer.

Why the study?

A drop in LVEF has limited diagnostic ability for trastuzumab-induced cardiotoxicity, and studies assessing serum biomarkers to detect early damage have yielded controversial results.

Do serum cardiac biomarkers predict early treatment-induced cardiotoxicity in patients with early breast cancer treated with adjuvant trastuzumab?

Population

Patients with early-stage breast cancer receiving adjuvant trastuzumab across 11 studies

Comparison

Different serum biomarkers for early prediction of cardiotoxicity

Authors

ECEsther Uña CidónRoyal Bournemouth HospitalTHTamas HickishDorset HealthCare University NHS Foundation TrustPAP.L. Madrigal Alonso

Discussion

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Implication

Troponins should guide early cardiotoxicity monitoring during trastuzumab; confirms their predictive value while challenging NT-proBNP utility.

Study Design

Type

Systematic Review (n=1,212)

Structured PICO

Do serum cardiac biomarkers predict early treatment-induced cardiotoxicity in patients with early breast cancer treated with adjuvant trastuzumab?

P
Population
1,212 women with early HER-2 positive breast cancer receiving adjuvant trastuzumab across 11 studies, monitored for early detection of cardiotoxicity using cardiac biomarkers.
E
Exposure
Serial measurement of serum cardiac biomarkers (NT-proBNP, troponins, CRP, MPO) before and during trastuzumab therapy
O
Outcome
Early prediction of treatment-induced cardiotoxicity (CTIC), defined heterogeneously across studies (mostly LVEF decline ≥10% to <55% or <50% with/without CHF symptoms)surrogate

Troponins I and T, but not NT-proBNP, show potential as predictive biomarkers for the early detection of trastuzumab-induced cardiotoxicity in patients with early breast cancer.

Limitations

  • Heterogeneous definitions of cardiotoxicity across included studies
  • Significant heterogeneity in threshold values for biomarker abnormality
  • Different assays used for biomarker determinations
  • Lack of standardized reference ranges
  • Heterogeneous definitions of CTIC
  • Variable threshold values for biomarker abnormality
  • Different assays used across studies
  • Missing data on cardiac risk factors in some studies

Cite This Study

Cidón et al. (2021) conducted a systematic review in Early-stage HER-2 positive breast cancer (n=1,212). Cardiac biomarkers (Troponins, NT-proBNP, CRP, MPO) vs. Normal biomarker levels was evaluated on Treatment-induced cardiotoxicity (CTIC). NT-proBNP was not predictive of trastuzumab-induced cardiotoxicity, whereas troponins I and T showed a predictive role for early detection in patients with early-stage breast cancer.

synapsesocial.com/papers/6a6f3025660549caf2c3bfbdhttps://doi.org/10.23954/osj.v6i1.2719
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1A Population-Based Study of Cardiovascular Mortality Following Early-Stage Breast Cancer2016 · 317 citations
  2. 2Cardiac Biomarkers in Patients with Cancer: Considerations, Clinical Implications, and Future Avenues2020 · 41 citations
  3. 3The Role of Biomarkers in Detection of Cardio-toxicity2017 · 30 citations
  4. 4Trastuzumab-Induced Cardiotoxicity: Clinical and Prognostic Implications of Troponin I Evaluation2010 · 641 citations
  5. 5Assessment of Echocardiography and Biomarkers for the Extended Prediction of Cardiotoxicity in Patients Treated With Anthracyclines, Taxanes, and Trastuzumab2012 · 826 citations