Role of serum biomarkers in cancer patients receiving cardiotoxic cancer therapies: a position statement from the Cardio-Oncology Study Group of the Heart Failure Association and the Cardio-Oncology Council of the European Society of Cardiology

Radek Pudil¹, Christian Mueller², Jelena Čelutkienė^{3

4}, Peter A Henriksen⁵, Dan Lenihan⁶, Susan Dent⁷, Ana Barac⁸, Susanna Stanway⁹, Javid Moslehi¹⁰, Thomas M Suter¹¹, Bonnie Ky¹², Martin Štěrba¹³, Daniela Cardinale¹⁴, Alain Cohen-Solal¹⁵, Carlo Gabriele Tocchetti¹⁶, Dimitrios Farmakis^{17

18

19}, Jutta Bergler-Klein²⁰, Markus S Anker²¹, Stephan Von Haehling^{22

23}, Yury Belenkov²⁴, Zaza Iakobishvili²⁵, Christoph Maack²⁶, Fortunato Ciardiello²⁷, Frank Ruschitzka²⁸, Andrew J S Coats^{29

30}, Petar Seferovic³¹, Mitja Lainscak³², Massimo F Piepoli³³, Ovidiu Chioncel^{34

35}, Jereon Bax³⁶, Jean-Sebastien Hulot³⁷, Hadi Skouri³⁸, Eva Simona Hägler-Laube³⁹, Riccardo Asteggiano⁴⁰, Teresa Lopez Fernandez⁴¹, Rudolf A de Boer⁴², Alexander R Lyon⁴³

Affiliations

¹ 1st Department Medicine - Cardioangiology, Charles University Prague, Medical Faculty and University Hospital Hradec Kralove, Prague, Czech Republic.
² Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.
³ Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
⁴ State Research Institute Centre For Innovative Medicine, Vilnius, Lithuania.
⁵ Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK.
⁶ Cardio-Oncology Center of Excellence, Washington University in St Louis, St Louis, MO, USA.
⁷ Duke Cancer Institute, Duke University, Durham, NC, USA.
⁸ MedStar Heart and Vascular Institute, Georgetown University, Washington, DC, USA.
⁹ Breast Unit, Royal Marsden Hospital, Surrey, UK.
¹⁰ Cardio-Oncology Program, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
¹¹ Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.
¹² University of Pennsylvania, Philadelphia, PA, USA.
¹³ Department of Pharmacology, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic.
¹⁴ Cardioncology Unit, European Institute of Oncology, IRCCS, Milan, Italy.
¹⁵ UMR-S 942, Paris University, Cardiology Department, Lariboisiere Hospital, AP-HP, Paris, France.
¹⁶ Department of Translational Medical Sciences and Interdepartmental Center for Clinical and Translational Research (CIRCET), 'Federico II' University, Naples, Italy.
¹⁷ University of Cyprus Medical School, Nicosia, Cyprus.
¹⁸ Cardio-Oncology Clinic, Heart Failure Unit, 'Attikon' University Hospital, Athens, Greece.
¹⁹ National and Kapodistrian University of Athens Medical School, Athens, Greece.
²⁰ Department of Cardiology, Medical University of Vienna, Vienna, Austria.
²¹ Division of Cardiology and Metabolism, Department of Cardiology, Charité and Berlin Institute of Health Center for Regenerative Therapies (BCRT) and DZHK (German Centre for Cardiovascular Research), partner site Berlin and Department of Cardiology, Charité Campus Benjamin Franklin, Berlin, Germany.
²² Department of Cardiology and Pneumology, University of Goettingen Medical Center, Goettingen, Germany.
²³ German Center for Cardiovascular Research (DZHK), partner site Goettingen, Goettingen, Germany.
²⁴ Sechenov Medical University, Moscow, Russia.
²⁵ Department of Community Cardiology, Tel Aviv Jaffa District, Clalit Health Fund and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
²⁶ Comprehensive Heart Failure Center, University Clinic Würzburg, Würzburg, Germany.
²⁷ Department of Precision Medicine, 'Luigi Vanvitelli' University of Campania, Naples, Italy.
²⁸ University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
²⁹ University of Warwick, Warwick, UK.
³⁰ Pharmacology Centre of Clinical and Experimental Medicine, IRCCS San Raffaele Pisana, Rome, Italy.
³¹ Faculty of Medicine and Serbian Academy of Sciences and Arts, University of Belgrade, Belgrade, Serbia.
³² University of Ljubljana, Ljubljana, Slovenia.
³³ Cardiac Department, 'Guglielmo da Saliceto' Polichirurgico Hospital AUSL Piacenza, Piacenza, Italy.
³⁴ Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', Bucharest, Romania.
³⁵ University of Medicine Carol Davila, Bucharest, Romania.
³⁶ Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
³⁷ Université de Paris, CIC1418, Paris Cardiovascular Research Center, INSERM, Paris, France.
³⁸ Cardiology Division, Internal Medicine Department at American University of Beirut Medical Center, Beirut, Lebanon.
³⁹ Inselspital, University Hospital of Bern, Bern, Switzerland.
⁴⁰ Cardiologist in Practice, Turin, Italy.
⁴¹ Cardiology Service, Cardio-Oncology Unit, La Paz University Hospital and IdiPAz Research Institute, Ciber CV, Madrid, Spain.
⁴² Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
⁴³ Cardio-Oncology Service, Royal Brompton Hospital and Imperial College London, London, UK.

PMID: 33006257
DOI: 10.1002/ejhf.2017

Free article

Role of serum biomarkers in cancer patients receiving cardiotoxic cancer therapies: a position statement from the Cardio-Oncology Study Group of the Heart Failure Association and the Cardio-Oncology Council of the European Society of Cardiology

Radek Pudil et al. Eur J Heart Fail. 2020 Nov.

Free article

. 2020 Nov;22(11):1966-1983.

doi: 10.1002/ejhf.2017. Epub 2020 Oct 20.

Authors

Affiliations

¹ 1st Department Medicine - Cardioangiology, Charles University Prague, Medical Faculty and University Hospital Hradec Kralove, Prague, Czech Republic.
² Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.
³ Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
⁴ State Research Institute Centre For Innovative Medicine, Vilnius, Lithuania.
⁵ Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK.
⁶ Cardio-Oncology Center of Excellence, Washington University in St Louis, St Louis, MO, USA.
⁷ Duke Cancer Institute, Duke University, Durham, NC, USA.
⁸ MedStar Heart and Vascular Institute, Georgetown University, Washington, DC, USA.
⁹ Breast Unit, Royal Marsden Hospital, Surrey, UK.
¹⁰ Cardio-Oncology Program, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
¹¹ Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.
¹² University of Pennsylvania, Philadelphia, PA, USA.
¹³ Department of Pharmacology, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic.
¹⁴ Cardioncology Unit, European Institute of Oncology, IRCCS, Milan, Italy.
¹⁵ UMR-S 942, Paris University, Cardiology Department, Lariboisiere Hospital, AP-HP, Paris, France.
¹⁶ Department of Translational Medical Sciences and Interdepartmental Center for Clinical and Translational Research (CIRCET), 'Federico II' University, Naples, Italy.
¹⁷ University of Cyprus Medical School, Nicosia, Cyprus.
¹⁸ Cardio-Oncology Clinic, Heart Failure Unit, 'Attikon' University Hospital, Athens, Greece.
¹⁹ National and Kapodistrian University of Athens Medical School, Athens, Greece.
²⁰ Department of Cardiology, Medical University of Vienna, Vienna, Austria.
²¹ Division of Cardiology and Metabolism, Department of Cardiology, Charité and Berlin Institute of Health Center for Regenerative Therapies (BCRT) and DZHK (German Centre for Cardiovascular Research), partner site Berlin and Department of Cardiology, Charité Campus Benjamin Franklin, Berlin, Germany.
²² Department of Cardiology and Pneumology, University of Goettingen Medical Center, Goettingen, Germany.
²³ German Center for Cardiovascular Research (DZHK), partner site Goettingen, Goettingen, Germany.
²⁴ Sechenov Medical University, Moscow, Russia.
²⁵ Department of Community Cardiology, Tel Aviv Jaffa District, Clalit Health Fund and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
²⁶ Comprehensive Heart Failure Center, University Clinic Würzburg, Würzburg, Germany.
²⁷ Department of Precision Medicine, 'Luigi Vanvitelli' University of Campania, Naples, Italy.
²⁸ University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
²⁹ University of Warwick, Warwick, UK.
³⁰ Pharmacology Centre of Clinical and Experimental Medicine, IRCCS San Raffaele Pisana, Rome, Italy.
³¹ Faculty of Medicine and Serbian Academy of Sciences and Arts, University of Belgrade, Belgrade, Serbia.
³² University of Ljubljana, Ljubljana, Slovenia.
³³ Cardiac Department, 'Guglielmo da Saliceto' Polichirurgico Hospital AUSL Piacenza, Piacenza, Italy.
³⁴ Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', Bucharest, Romania.
³⁵ University of Medicine Carol Davila, Bucharest, Romania.
³⁶ Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
³⁷ Université de Paris, CIC1418, Paris Cardiovascular Research Center, INSERM, Paris, France.
³⁸ Cardiology Division, Internal Medicine Department at American University of Beirut Medical Center, Beirut, Lebanon.
³⁹ Inselspital, University Hospital of Bern, Bern, Switzerland.
⁴⁰ Cardiologist in Practice, Turin, Italy.
⁴¹ Cardiology Service, Cardio-Oncology Unit, La Paz University Hospital and IdiPAz Research Institute, Ciber CV, Madrid, Spain.
⁴² Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
⁴³ Cardio-Oncology Service, Royal Brompton Hospital and Imperial College London, London, UK.

PMID: 33006257
DOI: 10.1002/ejhf.2017

Abstract

Serum biomarkers are an important tool in the baseline risk assessment and diagnosis of cardiovascular disease in cancer patients receiving cardiotoxic cancer treatments. Increases in cardiac biomarkers including cardiac troponin and natriuretic peptides can be used to guide initiation of cardioprotective treatments for cancer patients during treatment and to monitor the response to cardioprotective treatments, and they also offer prognostic value. This position statement examines the role of cardiac biomarkers in the management of cancer patients. The Cardio-Oncology Study Group of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) in collaboration with the Cardio-Oncology Council of the ESC have evaluated the current evidence for the role of cardiovascular biomarkers in cancer patients before, during and after cardiotoxic cancer therapies. The characteristics of the main two biomarkers troponin and natriuretic peptides are discussed, the link to the mechanisms of cardiovascular toxicity, and the evidence for their clinical use in surveillance during and after anthracycline chemotherapy, trastuzumab and HER2-targeted therapies, vascular endothelial growth factor inhibitors, proteasome inhibitors, immune checkpoint inhibitors, cyclophosphamide and radiotherapy. Novel surveillance clinical pathways integrating cardiac biomarkers for cancer patients receiving anthracycline chemotherapy or trastuzumab biomarkers are presented and future direction in cardio-oncology biomarker research is discussed.

Keywords: Anthracyclines; B-type natriuretic peptides; Biomarkers; Cardiac troponin; Cardio-oncology; Cardiotoxicity; HER2-targeted therapies; Heart failure; Immune checkpoint inhibitors; Myocarditis; Proteasome inhibitors; Radiotherapy; Vascular endothelial growth factor inhibitors.

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References

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Role of serum biomarkers in cancer patients receiving cardiotoxic cancer therapies: a position statement from the Cardio-Oncology Study Group of the Heart Failure Association and the Cardio-Oncology Council of the European Society of Cardiology

Affiliations

Role of serum biomarkers in cancer patients receiving cardiotoxic cancer therapies: a position statement from the Cardio-Oncology Study Group of the Heart Failure Association and the Cardio-Oncology Council of the European Society of Cardiology

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