Cancer cardiotoxicity and cardiac biomarkers

Abstract

Modern cancer therapies are highly effective in the treatment of malignancy; however, they are associated with the possible development of side effects, in particular involving heart function. This particular form of cardiotoxicity is related to many factors: Age, cumulative dose of the drug administered, drug combination, smoking, prior radiotherapy, and prior cardiovascular disease. Different types of events may manifest: The more important and difficult to manage is a progressive LV dysfunction, which may lead to the development of cardiac failure. Other side effects are represented by acute coronary syndromes, hypertension, thromboembolic events, and arrhythmias. Anthracyclines are one of the anticancer drugs more studied, and they are known to cause CTX through different molecular mechanisms; the damage induced by AC is dose dependent and usually irreversible. Also newer therapies like targeted therapy (i.e., trastuzumab) or angiogenesis inhibitors are all associated with some form of cardiac toxicity: While targeted drugs may induce a reversible damage, angiogenesis inhibitors have a prothrombotic activity, which leads to a high incidence of thromboembolic events. Patients were followed up with serial cardiological visits and evaluation of the LVEF, which however detects the damage already installed. In the last 20 years, a new appealing approach has been proposed: It is based on the evaluation of circulating troponin and/or natriuretic peptides. Especially for troponin, many studies underlined the predictive value of this marker, which can detect minimal cardiac damage, well before the onset of cardiac dysfunction, allowing for a personalized follow-up and cardiological preventive treatment. In this light, many studies have recently evaluated the protective effect of different drugs, such as dexrazoxane, beta blockers, and ACE inhibitors, with in some cases very promising results.