According to new research, biomarkers that signal whether a patient's cancer treatment may be harming their heart have been identified. Through the use of a blood test at the beginning of treatment, these biomarkers could also allow doctors to assess the cardiovascular adverse effects (AEs) of chemotherapy.1

Cardiovascular problems are a potential AE of certain cancer therapies. Anthracyclines, a type of chemotherapy drug, carry a particularly high risk for these AEs, with approximately 17% of patients who receive anthracycline needing to stop treatment due to cardiac complications.1
 
The typical method of identifying heart damage is using echocardiograms, an ultrasound of the heart, at various points throughout treatment. Yet, echocardiograms are only able to show signs of damage after it has already occurred and they are also quite expensive.1

“Compared to the current standards for diagnosing chemotherapy-related cardiac dysfunction (CRCD), the biomarker panel we have suggested would be cost effective and easy to implement, but more importantly, would aid in earlier diagnosis, risk assessment and CRCD progression monitoring that would ultimately improve patient care and outcomes,” said co-author Hari Vishal Lakhani, PhD, a clinical research associate at the Marshall University Joan C. Edwards School of Medicine, in a press release. “It is especially relevant to patients in rural, lower socioeconomic communities, who may not be have access to serial echocardiography as a means to diagnose CRCD.”1

Lakhani was scheduled to speak at the American Society for Investigative Pathology annual meeting in San Diego this month in order to present this new research. After the meeting was canceled in response to the coronavirus disease 2019 pandemic, the researchers published the study’s abstract in the April issue of The FASEB Journal.1

In the study, the researchers used blood samples from 17 healthy women in order to compare them with samples from 17 women undergoing anthracycline treatment for breast cancer. Additionally, those women undergoing anthracycline treatment also received echocardiograms before beginning the treatment, and then again 3 and 6 months after the start of treatment.1

The results of the study demonstrated statistically significant differences in the levels of 12 biomarkers related to cardiovascular changes between the 2 groups of women. Although the researchers did not find a single biomarker that was sufficient to predict CRCD, the 12 biomarkers together provided a reliable predictor of heart toxicity, which was then validated through the use of echocardiography. Many of the biomarkers also presented changes that the researchers were able to detect well before heart damage was noticeable on an echocardiogram.1

The 12 biomarkers identified include a variety of proteins, as well as microRNAs (miRNAs), which affect gene expression. The identified miRNAs in the group have been previously implicated in cardiac dysfunction in other research, and the identified proteins have been linked with inflammation, damage to the heart muscle, and other processes involved in heart disease in prior research as well.1

“Our results support the clinical application of these serum biomarkers and circulating miRNAs to develop a panel for early diagnosis of chemotherapy-related cardiac dysfunction, which will enable early detection of disease progression and management of irreversible cardiac damage,” Lakhani said in a press release. “A biomarker panel may in fact be better than serial echocardiography, because the information gathered from a biomarker panel could allow appropriate intervention to be taken before any cardiac damage has occurred.”1

These results are important because knowing in advance whether a patient presents signs of heart problems would allow physicians to quickly adjust the chemotherapy type or dosage, or prescribe the appropriate medications to prevent heart failure. By giving physicians this necessary information early on, the treatment outcomes for patients who would otherwise suffer illness or death as a result of chemotherapy-related heart problems would be improved, Lakhani said.1


REFERENCE
  1. Blood test offers early warning of chemotherapy-related heart problems [news release]. Eurekalert; April 27, 2020. Bethesda, MD: American Society for Investigative Pathology. eurekalert.org/pub_releases/2020-04/eb-bto042320.php. Accessed April 29, 2020.