NT-proBNP (OR 1.03; 95% CI 1.008-1.055; P=0.01) and hemoglobin measured at 6 weeks were significantly associated with cardiotoxic reactions during neo-adjuvant chemotherapy for early-stage breast cancer.
RCT (n=853)
Randomized
Yes
Do NT-proBNP and high-sensitivity cardiac troponin T predict cardiotoxic reactions in patients with early-stage breast cancer undergoing dose-dense and dose-intensified chemotherapy?
Early increases in NT-proBNP and hemoglobin, but not high-sensitivity cardiac troponin T, are significantly associated with the development of cardiotoxic reactions in patients with early-stage breast cancer undergoing intensive chemotherapy.
p-value: p=0.31
Background Patients with breast cancer can be affected by cardiotoxic reactions through cancer therapies. Cardiac biomarkers, like NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) and high‐sensitivity cardiac troponin T, might have predictive value. Methods and Results Echocardiography, ECG, hemodynamic parameters, NT‐proBNP and high‐sensitivity cardiac troponin T were assessed in 853 patients with early‐stage breast cancer randomized in the German Breast Group GeparOcto‐GBG 84 phase III trial. Patients received neo‐adjuvant dose‐dense, dose‐intensified epirubicin, paclitaxel, and cyclophosphamide (iddEPC group, n=424) or paclitaxel, non‐pegylated doxorubicin, and in triple negative breast cancer, (paclitaxel, non‐pegylated doxorubicin, carboplatin group, n=429) treatment for 18 weeks. Patients positive for human epidermal growth receptor 2 (n=354, 41.5%) received monoclonal antibodies on top of allocated therapy; 119 (12.9%) of all patients showed a cardiotoxic reaction during therapy (15 1.8% using a more strict definition). Presence of cardiotoxic reactions was irrespective of treatment allocation ( P =0.31). Small but significant increases in NT‐proBNP developed early in patients with a cardiotoxic reaction as compared with those without in whom NT‐proBNP rose only towards the end of therapy ( P =0.04). High‐sensitivity cardiac troponin T rose early in both groups. Logistic regression showed that NT‐proBNP (odds ratio OR, 1.03; 95% CI, 1.008–1.055; P =0.01) and hemoglobin (OR, 1.31; 95% CI, 1.05–1.63; P =0.02) measured at 6 weeks after treatment initiation were significantly associated with cardiotoxic reactions. Conclusions NT‐proBNP and hemoglobin are significantly associated with cardiotoxic reactions in patients with early‐stage breast cancer undergoing dose‐dense and dose‐intensified chemotherapy, but high‐sensitivity cardiac troponin T is not. Registration URL: http://www.clinicaltrials.gov ; Unique identifier: NCT02125344.
Rüger et al. (Mon,) conducted a rct in Early-stage breast cancer (n=853). Neo-adjuvant dose-dense, dose-intensified epirubicin, paclitaxel, and cyclophosphamide (iddEPC) vs. Paclitaxel, non-pegylated doxorubicin, with or without carboplatin was evaluated on Cardiotoxic reaction during therapy (p=0.31). NT-proBNP (OR 1.03; 95% CI 1.008-1.055; P=0.01) and hemoglobin measured at 6 weeks were significantly associated with cardiotoxic reactions during neo-adjuvant chemotherapy for early-stage breast cancer.