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Predicting Cancer Therapy-Induced Cardiotoxicity

The Role of Troponins and Other Markers

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Abstract

Several anticancer drugs have been associated with cardiac toxicity, especially the anthracyclines and trastuzumab. The pathogenesis of anthracycline-associated toxicity has been well described, whereas the mechanism of trastuzumab-associated toxicity is unknown. Although routine cardiac imaging studies (e.g. echocardiogram or multiple gated acquisition scans) may identify subclinical evidence of myocardial dysfunction, available data do not support their routine use for monitoring asymptomatic patients undergoing cancer therapy. Other modalities such as nuclear medicine scintigraphy with indium-111-antimyosin antibody and endomyocardial biopsy have been shown to be useful in identifying early cardiac damage, but their routine use is limited by practical considerations such as feasibility and cost. Consequently, there is significant interest in developing simple and reproducible methods for identifying patients at risk for treatment-induced myocardial damage. Available data suggest that circulating markers such as troponins and natriuretic peptides could potentially be useful for this purpose. Measurement of plasma troponin levels are commonly used in clinical practice in order to provide diagnostic and prognostic information in patients with myocardial ischaemia. Elevated levels may likewise correlate with anthracycline-induced cardiac damage, although plasma levels are only minimally elevated (well below that associated with ischaemia), and elevations may persist for weeks or months after anthracycline exposure. Clinical trials are currently evaluating the role of these markers in predicting both early and late, clinical and subclinical damage associated with anthracyclines and trastuzumab.

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The authors have received no funding for the preparation of this manuscript, nor have any conflicts of interest directly relevant to the contents of this manuscript.

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  1. Department of Oncology, 2 South, Room 2S-47, Albert Einstein Cancer Center/Montefiore Medical Center — Weiler Division, 1825 Eastchester Road, Bronx, New York, 10461, USA

    Joseph A. Sparano

  2. Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA

    David L. Brown

  3. The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, USA

    Antonio C. Wolff

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Sparano, J.A., Brown, D.L. & Wolff, A.C. Predicting Cancer Therapy-Induced Cardiotoxicity. Drug-Safety 25, 301–311 (2002). https://doi.org/10.2165/00002018-200225050-00001

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