The role of cardiac biomarkers as predictors of trastuzumab cardiotoxicity in patients with breast cancer
Aim: Identification of patient with increased risk of cardiotoxicity would allow not only prevention and early diagnosis of chemotherapy related cardiotoxicity but also administration of optimal dose and duration of chemotherapy. Materials and methods: Fifty-two women with HER2+ breast cancer treate...
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Інститут експериментальної патології, онкології і радіобіології ім. Р.Є. Кавецького НАН України
2015
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| Cite this: | The role of cardiac biomarkers as predictors of trastuzumab cardiotoxicity in patients with breast cancer / Y. Ürün, G. Utkan, B. Yalcin, H. Akbulut, H. Onur, D. G. Oztuna, F.Ç. Şenler, A. Demirkazık, F. İçli // Experimental Oncology. — 2015. — Т. 37, № 1. — С. 53-57. — Бібліогр.: 39 назв. — англ. |
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Digital Library of Periodicals of National Academy of Sciences of Ukraine| _version_ | 1860268518275022848 |
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| author | Ürün, Y. Utkan, G. Yalcin, B. Akbulut, H. Onur, H. Oztuna, D.G. Şenler, F.Ç. Demirkazık, A. İçli, F. |
| author_facet | Ürün, Y. Utkan, G. Yalcin, B. Akbulut, H. Onur, H. Oztuna, D.G. Şenler, F.Ç. Demirkazık, A. İçli, F. |
| citation_txt | The role of cardiac biomarkers as predictors of trastuzumab cardiotoxicity in patients with breast cancer / Y. Ürün, G. Utkan, B. Yalcin, H. Akbulut, H. Onur, D. G. Oztuna, F.Ç. Şenler, A. Demirkazık, F. İçli // Experimental Oncology. — 2015. — Т. 37, № 1. — С. 53-57. — Бібліогр.: 39 назв. — англ. |
| collection | DSpace DC |
| container_title | Experimental Oncology |
| description | Aim: Identification of patient with increased risk of cardiotoxicity would allow not only prevention and early diagnosis of chemotherapy related cardiotoxicity but also administration of optimal dose and duration of chemotherapy. Materials and methods: Fifty-two women with HER2+ breast cancer treated with trastuzumab were included in this study. Patients were prospectively followed with routine cardiac evaluation. Before and after administration of trastuzumab blood samples for NT-proBNP were also taken. Results: The median age was 48.5 year (range: 26–74). Hypertension and obesity were two most common co-morbidities. The median duration application of trastuzumab was 52 weeks. During median 14.5 (3–33) months follow-up cardiac adverse events occurred in 5 (9.6%) patients and 2 out of 5 was grade III–IV heart failure. Both patients had preserved left ventricular ejection fraction and no symptom of heart failure before trastuzumab but older than 65 years old and had diabetes mellitus and obesity. High level of NT-proBNP (> 300 ng/ml) was observed in both patients and heart failure recovery was not observed. There was statistically significant difference regarding body mass index (p = 0.004) and diabetes mellitus (p = 0.002) between patients with and without cardiotoxicity. Conclusion: Although, cardiac biomarkers still cannot replace routine cardiac monitoring, natriuretic peptides may provide additional tool for detection of patients with high risk of cardiotoxicity and early detection of cardiotoxicity. Key Words: breast cancer, trastuzumab, heart failure, left ventricular dysfunction, natriuretic peptides.
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| first_indexed | 2025-12-07T19:03:53Z |
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Experimental Oncology 37, 53–57, 2015 (March) 53
THE ROLE OF CARDIAC BIOMARKERS AS PREDICTORS
OF TRASTUZUMAB CARDIOTOXICITY IN PATIENTS
WITH BREAST CANCER
Y. Ürün1,2*, G. Utkan1, B. Yalcin3, H. Akbulut1, H. Onur1, D.G. Oztuna4, F.Ç. Şenler1, A. Demirkazık1, F. İçli1
1Department of Medical Oncology, Ankara University School of Medicine, Ankara 06590, Turkey
2Department of Medical Oncology, Gaziantep Dr. Ersin Arslan State Hospital, Gaziantep 27310, Turkey
3Department of Medical Oncology, Yildirim Beyazit University School of Medicine, Atatürk Education
and Research Hospital, Ankara 06800, Turkey
4Department of Biostatistics, Ankara University School of Medicine, Ankara 06100, Turkey
Aim: Identification of patient with increased risk of cardiotoxicity would allow not only prevention and early diagnosis of chemo-
therapy related cardiotoxicity but also administration of optimal dose and duration of chemotherapy. Materials and methods: Fifty-
two women with HER2+ breast cancer treated with trastuzumab were included in this study. Patients were prospectively followed
with routine cardiac evaluation. Before and after administration of trastuzumab blood samples for NT-proBNP were also taken.
Results: The median age was 48.5 year (range: 26–74). Hypertension and obesity were two most common co-morbidities. The me-
dian duration application of trastuzumab was 52 weeks. During median 14.5 (3–33) months follow-up cardiac adverse events
occurred in 5 (9.6%) patients and 2 out of 5 was grade III–IV heart failure. Both patients had preserved left ventricular ejection
fraction and no symptom of heart failure before trastuzumab but older than 65 years old and had diabetes mellitus and obesity. High
level of NT-proBNP (> 300 ng/ml) was observed in both patients and heart failure recovery was not observed. There was statisti-
cally significant difference regarding body mass index (p = 0.004) and diabetes mellitus (p = 0.002) between patients with and
without cardiotoxicity. Conclusion: Although, cardiac biomarkers still cannot replace routine cardiac monitoring, natriuretic
peptides may provide additional tool for detection of patients with high risk of cardiotoxicity and early detection of cardiotoxicity.
Key Words: breast cancer, trastuzumab, heart failure, left ventricular dysfunction, natriuretic peptides.
Breast cancer (BC) is most common cancer and
second leading cause of cancer death among women
in developed countries [1]. BC is heterogeneous disease
with different genetic and clinicopathologic features.
Almost one-fourth of the patients show overexpression
of human epidermal growth factor receptor 2 (HER2) [2,
3]. Treatment targeting HER2, such as trastuzumab, has
dramatically changed clinical course of those patients
[4, 5]. Although, the exact mechanism is still unclear,
trastuzumab is associated with cardiotoxicity in subset
of patients [4–9]. According to recent Cochrane meta-
analysis, trastuzumab significantly increases the frequen-
cy of left ventricular ejection fraction decline and the risk
of symptomatic heart failure (HF) [10, 11]. American
College of Cardio logy Foundation/American Heart Asso-
ciation (ACCF/AHA) guidelines classify patients receiving
cardiotoxins as stage A HF, and recommend aggressive
control and treatment of modifiable risk factors [12]. For
that reason, optimal cardiac management is crucial for
both prevention and early diagnosis of chemotherapy
related cardiotoxicity. In addition, because the optimal
survival benefit of adjuvant trastuzumab achieved with
one-year treatment, it is also important for optimal dose
and duration of chemotherapy [13–15].
Clinical trials usually include selected patients who
are usually under 65 and without serious co-morbidi-
ties. Nonetheless, the median age of patients with
BC is over the 60, and 40% of patients are over 65, and
20% over 75 [1, 10, 11, 16]. Older women has higher
risk of cardiotoxicity. Therefore, clinical trials may not
represent real world. In additionally, median survival
of patients with BC has been improved. The estimated
5 year overall survival is also reached to 80–85% for
patients who were diagnosed between 1999–2005 [1,
17]. Finally, number of cancer survivors has been
increased and late toxicities become more important
for those patients.
HF is a complex clinical syndrome. According
to underlying cause, while half of patients present with
HF with reduced ejection fraction (HFrEF), second
half have HF with preserved ejection fraction (HF-
pEF). The diagnosis of HFpEF is more challenging.
HFpEF are usually observed in obese older women
with a history of hypertension, diabetes mellitus
(DM), and hyperlipidemia [12, 18]. There is no single
test for the diag nosis of HF but ejection fraction (EF)
is consi dered important in classification of patients
with HF and response to treatments. Also clinical tri-
als usually selected patients based on EF. However,
measurement of EF is dependent operator, imaging
technique, and method of analysis. B type natriuretic
peptides (BNP) are secreted by ventricular cardio-
myocytes in response to increased ventricular stretch.
Submitted: January 20, 2015.
*Correspondence: Fax: +903123192283;
E-mail: yukselurun@gmail.com
Abbreviations used: BMI — body mass index; BC — breast can-
cer; CAD — coronary arterial disease; DM — diabetes mellitus;
EF — ejection fraction; HF — heart failure; HFpEF — heart failure
with preserved ejection fraction; HFrEF — heart failure with redu-
ced ejection fraction; LVEF — left ventricular ejection fraction;
MUGA — multiple-gated acquisition scanning.
Exp Oncol 2015
37, 1, 53–57
54 Experimental Oncology 37, 53–57, 2015 (March)
After release of propeptide (proBNP), it converts
in to biologically inert amino terminal (NT-proBNP)
and biologically active BNP [19]. The role of BNP and
NT-proBNP has been well defined in diagnosis of both
HFrEF and HFpEF [12, 20, 21]. EF alone may not pre-
dict cardioto xicity of chemotherapy for all patients and
the optimal monitoring and treatment algorithm for
trastuzumab related cardiotoxicity remain to be es-
tablished. The purpose of this study was to evaluate
the role of serum biomarker in early diagnosis or pre-
diction of trastuzumab related cardiotoxicity.
MATERIALS AND METHODS
Patients. All patients with HER2-positive BC who
were treated with trastuzumab either single-agent
or combined with chemotherapy agents were included
in this study. Demographic and clinical data of patients
were reported on case record forms designed for data
collection for this study. Patient characteristics con-
sidered relevant for cardiotoxicity were age, Eastern
Cooperative Oncology Group (ECOG) performance
status, prior anthracycline therapy, prior radiotherapy,
hypertension, DM, hyperlipidemia, obesity, and renal
failure. This study was approved by the Institutional
Review Board of Ankara University School of Medicine
and was conducted according to Helsinki Declaration
and good clinical practice.
Biochemical measurements. All blood samples
were collected after 5 min supine rest and 30 min
before and 30 min after trastuzumab administration.
Samples were immediately centrifuged and separated
sera were stored at −80 °C at the hospital laboratory
until assayed. Before assay performed all samples
were anonymized. NT-proBNP was measured using
the commercially available electrochemiluminescence
immuno-assay (Roche Cobas e601, Roche Diagnos-
tics GmbH, D-68298 Mannheim, Germany). The staff
that performed assay was masked to the patient’s di-
agnosis and cardiac status.
Cardiac tests. Routine cardiac evaluation of all
patients was performed before trastuzumab treatment
and follow-up echocardiography or Multiple-Gated Ac-
quisition scanning (MUGA) scan were performed every
3 months during treatment and also in case of HF related
symptoms. A cardiac event was defined as the deve-
lopment of symptomatic HF or more than 10% decline
of left ventricular ejection fraction (LVEF). Grading of all
toxicities was done according to National Cancer Insti-
tute Common Terminology Criteria for Adverse Events
(CTCAE, version 4.0, published May 28, 2009).
Statistical analysis. Statistical analysis was
carried out using the computer program Statistical
Package for the Social Sciences 11.5 for Windows
(SPSS, Inc, Chicago, IL, USA). Frequency (percent)
or median (minimum-maximum) was given as de-
scriptive statistics. Chi-square test was used to deter-
mine differences in proportions. p Value of less than
0.05 was considered as statistically significant.
RESULTS
The median age of patients was 48.5 year
(range: 26–74). Hypertension and obesity were two
most common co-morbidities. Patients’ basal and
pre-trastuzumab characteristics were summarized
at Table 1 and 2.
Table 1. Patients’ basal characteristics
Parameters n (%)
Age, year
Median, range 48.5 (26.0–74.0)
Menopausal status, n (%)
Pre- 26 (50.0)
Peri- 4 (7.7)
Post- 22 (42.3)
Hypertension 11 (21.2)
DM 8 (15.4)
Coronary arterial disease (CAD) 1 (1.9)
Hyperlipidemia 6 (11.5)
Smoking 5 (9.6)
Body mass index (BMI), kg/m2
Median, range 28 (18.0–41.1)
< 25 9 (17.3)
25–30 25 (48.1)
> 30 18 (34.6)
Creatinin, mg/ml 0.77 (0.36–1.0)
Glucose, mg/ml 95 (77.0–202.0)
Triglyceride, mg/ml 113.5 (44.0–256.0)
High-density lipoprotein, mg/ml 50.5 (34.0–75.0)
Uric acid, mg/ml 3.6 (2.4–6.2)
Table 2. Pretrastuzumab patients’ BC features
Features Number patients
n = 52 %
ECOG performance status
0 45 86.5
1 7 13.5
Laterality
Right 20 38.5
Left 32 61.5
Stage
Metastatic 14 26.9
Non-metastatic 38 73.1
Estrogen receptors
Positive 35 67.3
Negative 17 32.7
Progesterone receptors
Positive 40 76.9
Negative 12 23.1
HER2
İmmunohistochemistry (+3) 51 98.0
FISH/CISH 1 2.0
Pre-trastuzumab anthracycline#
No 13 25.0
Yes 39 75.0
Radiotherapy (n = 25)
Right breast 9 36.0
Left breast 16 64.0
Hormonal treatment (n = 46)
Tamoxifen 34 73.9
Aromatase inhibitor 12 26.1
#Total anthracycline dose, median (mg/m2): doxorubicin — 240, epirubicin —
300. Time from last anthracycline administration to trastuzumab, median
(range), month: 1 (1–110). Trastuzumab therapy duration, median (range),
week: 52 (9–120).
The median duration of trastuzumab application
was 52 weeks. None of patients was given concur-
rently anthracycline and trastuzumab. During median
14.5 (3–33) months follow-up cardiac adverse events
occurred in 5 (9.6%) patients. Grade III–IV HF ob-
served in 2 (3.8%) patients. Although both patients had
normal EF and no symptom of HF before trastuzumab,
high level of NT-proBNP was observed for both before
and post trastuzumab. Asymptomatic LVEF decrease
was observed in 3 (5.6%) patients. After discontinu-
ation of trastuzumab cardiac recovery was observed
Experimental Oncology 37, 53–57, 2015 (March) 55
in 3 patients with asymptomatic EF decrease. However,
in 2 patients with symptomatic HF recovery was not ob-
served and both patients was older than 65 years-old
and had DM and obesity (Table 3 and 4). Overall, there
was statistically significant difference regarding BMI
(p = 0.004) and DM (p = 0.002) between patients who
have manifested and not manifested cardiac toxicity.
Table 3. Cardiac characteristics of patients
Cardiac characteristics Median (range)
Pretrastuzumab Posttrastuzumab
Heart rate, per minute 78 (56—104) 76 (62–108)
EF, % 65 (55—75) 62 (40—77)
NT-proBNP level, pg/ml 50 (5—694) 49 (5—829)
CK-MB level, ng/ml 1.33 (0.49—2.82) 1.35 (0.09—3.12)
DISCUSSION
The data from this study show that, a higher level
of NT-proBNP is associated with cardiotoxicity even
in patients with preserved baseline LVEF. Older patients
with high BMI and with history of DM have higher risk
trastuzumab related cardiotoxicity. Although HF is usu-
ally reversible after discontinuation of trastuzumab and
appropriate treatment of HF, patients with NT-proBNP
higher than 300 pg/ml were unlikely recovered from HF.
Cancer and CAD are two leading causes of death.
These two diseases combined accounted for ap-
proximately half of deaths in the developed countries.
While overall CAD mortality has shown a downward
trend, the incidence and prevalence of HF has still
exhi bited an upward trend [22]. In the last 2 decades,
new classes of treatment provided improvement
in survival and have been approved for the treatment
of various type of cancer. On the other hand, new type
of toxicities has been also witnessed. While these
toxicities were mostly associated with morbidity and
affect quality of life, treatment related mortality was
also reported [23]. In addition, these toxicities lead
to treatment interruptions and discontinuation that
results in inferior treatment outcome.
Cardiotoxicity is well known anthracyclines related
toxicity and usually dose dependent, predictable, and
irreversible. Although, it may occur during relatively
new treatment such as trastuzumab, bevacizumab,
and tyrosine kinase inhibitors [24–26]. The cardio-
toxicity of these drugs usually dose independent
and reversible. Trastuzumab is a monoclonal anti-
body against HER2 receptor, which over expressed
in 20–25% of BC. Although the exact mechanism
is not clear yet, trastuzumab related cardiotoxicity has
been well established in randomized clinical trials and
meta-analysis. Age, obesity, history of heart disease
and use of anthracyclines are known risk factors for
trastuzumab related cardiotoxicity. Although lifetime
risk of BC is increased with age, in our population
we see BC at earlier age than US women. Almost half
of patients with BC are under 50 in our country [27].
Likewise, median age was 48.5 years old in present
study. However, both groups of patients with irrever-
sible HF were older than 65 years old.
In early study, Slamon et al. [5] showed the survival
advantage of adding trastuzumab to chemotherapy
in patients with advanced BC. However, in this study
also carditoxicity was frequently observed. The fre-
quency of New York Heart Association (NYHA) class
III–IV cardiac dysfunction was 27 and 13% in patients
who were treated with anthracycline, cyclophospha-
mide plus trastuzumab and paclitaxel plus trastu-
zumab, respectively. After these results, baseline and
follow-up cardiac monitoring were added subsequent
trial. Despite strict inclusion criteria, carditoxicity is still
occurred in clinical trials. According to recently pub-
lished Cochrane review, in patient with early BC, who
has high chance of cure, trastuzumab increased risk
of HF 5 fold and LVEF decline 2 fold [11]. Randomized
controlled trials have generally excluded older patients
with major comorbidities. Therefore, frequency of car-
diotoxicity is expected to be more common in the real
world. Recently, Bowles et al. [6] reported population
based retrospective cohort study of 12 500 women with
BC. At median 4.4 years follow up time, the risk of HF/
cardiomyopathy was 4 to 7 fold higher in patients with
trastuzumab alone or anthracycline plus trastuzumab.
In addition, the risk of HF has been continued to increase
during follow — up. In another population based study
from Italian Cardio-Oncologic Network, trastuzumab
cardiotoxicity rate was 27% and also treatment inter-
ruption rate was higher than clinical trials [28].
Due to, patients on chemotherapy were consi-
dered as stage A HF, patient with risk of developing
HF, preventive intervention, early detection and treat-
ment of chemotherapy-induced cardiotoxicities are
Table 4. Characteristics’ of 5 patients with cardiotoxicity
Clinical characteristics Patient
1a 2a 3a 4b 5b
Pretrastuzumab age, years 66 72 48 52 44
Menopausal status Post- Post- Post- Pre- Pre-
Hypertension No Yes No No No
DM Yes Yes Yes Yes No
BMI, kg/m2 30.92 31.39 31.08 30.22 25.31
Total anthracycline dose, mg/m2 600 (E) No 60 (A) 240 (A) 180 (A)
Radiotherapy No No No Yes No
Chemotherapy# 6EC5TH 6TCH7H A6TH14H 4AC4TH13H 3AC3TH5H
Creatinin, mg/dl 1.0 0.97 0.8 0.55 0.73
Pretrastuzumab, EF, % 55.0 60.0 62.5 55.0 60.0
Pretrastuzumab, NT-proBNP level, pg/ml 370 694 41 49 72
Posttrastuzumab, EF, % 35 40 48 49 52
Posttrastuzumab, NT-proBNP level, pg/ml 426 829 43 44 104
Cardiac status after discontinuation of trastuzumab Symptomatic HF Symptomatic HF Recover after
2 months EF: 65%
Recover after
4 months EF: 55%
Recover after
3 months EF: 60%
aMetastatic disease. bAdjuvant treatment. #Chemotherapy was administered every 3 weeks. A — adriamycine; C — cyclophosphamide; E — epirubicine;
H — trastuzumab; T — docetaxel.
56 Experimental Oncology 37, 53–57, 2015 (March)
needed for reducing severe, irreversible, late onset
cardiotoxicity and optimal treatment of cancer. In daily
clinical practice calculation of EF, by echocardiogra-
phy or MUGA scan, is most widely used method [29].
However, because of EF does not usually decrease
in early stage HF, EF has some limitations for early
detection or prediction of late onset left ventricular
dysfunction. In addition, half of patients with HF have
HFpEF despite lower risk of death than patient with
HFrEF, those patients mortality rate is still high [30–32].
As well as, echocardiography is mostly operator de-
pendent and MUGA scan causes radiation exposure.
Therefore, non-invasive predictive and prognostic
tests of HF for patients on chemotherapy are needed.
The role of serum biomarker such a troponin, natriure-
tic peptides has been well established by meta-
analysis and both BNP and NT-proBNP are endorsed
in current guidelines plus clinical evaluation [20,
33–36]. The normal level of BNP/NT-proBNP are very
low and increased myocardial wall stress lead to eleva-
tion of serum level [21, 34, 37]. In contrast to the echo-
cardiography and MUGA scan, HFpEF and diastolic
HF may cause elevated BNP/NT-proBNP. However,
not only CAD but advancing age and renal dysfunc-
tion might cause higher levels, while lower levels may
be detected in patients with obesity and overt HF [21,
37]. Although, adjusted cutoff values are proposed for
renal dysfunction and obesity, <30–50 pg/ml of BNP
and <300 pg/ml of NT-proBNP have high accuracy
for excluding HF. In additionally, the prognostic value
of natriuretic peptides has also been reported and
higher values were associated with worse progno-
sis [21]. Likewise, patient without history of HF and
with elevated natriuretic peptides levels are at higher
risk for cardiovascular events [38]. In two recent meta-
analysis Felker et al. and Porapakkham et al. reported
that biomarker guided treatment of HF was associated
with 31% and 24% reduction in all causes of morta lity
compared to routine daily practice in patients with
HF [33, 39]. Therefore, not only for diagnosis but also
for optimizing treatment and reduction in mortality,
natriuretic peptides may have additional value.
This study has several limitations: our cohort
has smaller sample size and possibly fewer events,
so the analyses were primarily exploratory, so, no de-
finitive conclusions cannot be drawn. However, it sup-
ports of the potential clinical application of NT-proBNP
as a predictive marker to consider cardiac manage-
ment of patients treated with trastuzumab.
In conclusion, although, cardiac biomarkers still
cannot replace routine cardiac monitoring, natriuretic
peptides may provide additional tool for detection
of patients with high risk of cardiotoxicity and early
detection of cardiotoxicity.
ACKNOWLEDGEMENTS
The authors would like to thank all patients for
participation of this study.
DISCLOSURE
None of the authors had a conflict of interest.
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Copyright © Experimental Oncology, 2015
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| id | nasplib_isofts_kiev_ua-123456789-145446 |
| institution | Digital Library of Periodicals of National Academy of Sciences of Ukraine |
| issn | 1812-9269 |
| language | English |
| last_indexed | 2025-12-07T19:03:53Z |
| publishDate | 2015 |
| publisher | Інститут експериментальної патології, онкології і радіобіології ім. Р.Є. Кавецького НАН України |
| record_format | dspace |
| spelling | Ürün, Y. Utkan, G. Yalcin, B. Akbulut, H. Onur, H. Oztuna, D.G. Şenler, F.Ç. Demirkazık, A. İçli, F. 2019-01-21T21:19:51Z 2019-01-21T21:19:51Z 2015 The role of cardiac biomarkers as predictors of trastuzumab cardiotoxicity in patients with breast cancer / Y. Ürün, G. Utkan, B. Yalcin, H. Akbulut, H. Onur, D. G. Oztuna, F.Ç. Şenler, A. Demirkazık, F. İçli // Experimental Oncology. — 2015. — Т. 37, № 1. — С. 53-57. — Бібліогр.: 39 назв. — англ. 1812-9269 https://nasplib.isofts.kiev.ua/handle/123456789/145446 Aim: Identification of patient with increased risk of cardiotoxicity would allow not only prevention and early diagnosis of chemotherapy related cardiotoxicity but also administration of optimal dose and duration of chemotherapy. Materials and methods: Fifty-two women with HER2+ breast cancer treated with trastuzumab were included in this study. Patients were prospectively followed with routine cardiac evaluation. Before and after administration of trastuzumab blood samples for NT-proBNP were also taken. Results: The median age was 48.5 year (range: 26–74). Hypertension and obesity were two most common co-morbidities. The median duration application of trastuzumab was 52 weeks. During median 14.5 (3–33) months follow-up cardiac adverse events occurred in 5 (9.6%) patients and 2 out of 5 was grade III–IV heart failure. Both patients had preserved left ventricular ejection fraction and no symptom of heart failure before trastuzumab but older than 65 years old and had diabetes mellitus and obesity. High level of NT-proBNP (> 300 ng/ml) was observed in both patients and heart failure recovery was not observed. There was statistically significant difference regarding body mass index (p = 0.004) and diabetes mellitus (p = 0.002) between patients with and without cardiotoxicity. Conclusion: Although, cardiac biomarkers still cannot replace routine cardiac monitoring, natriuretic peptides may provide additional tool for detection of patients with high risk of cardiotoxicity and early detection of cardiotoxicity. Key Words: breast cancer, trastuzumab, heart failure, left ventricular dysfunction, natriuretic peptides. The authors would like to thank all patients for participation of this study. en Інститут експериментальної патології, онкології і радіобіології ім. Р.Є. Кавецького НАН України Experimental Oncology Original contributions The role of cardiac biomarkers as predictors of trastuzumab cardiotoxicity in patients with breast cancer Article published earlier |
| spellingShingle | The role of cardiac biomarkers as predictors of trastuzumab cardiotoxicity in patients with breast cancer Ürün, Y. Utkan, G. Yalcin, B. Akbulut, H. Onur, H. Oztuna, D.G. Şenler, F.Ç. Demirkazık, A. İçli, F. Original contributions |
| title | The role of cardiac biomarkers as predictors of trastuzumab cardiotoxicity in patients with breast cancer |
| title_full | The role of cardiac biomarkers as predictors of trastuzumab cardiotoxicity in patients with breast cancer |
| title_fullStr | The role of cardiac biomarkers as predictors of trastuzumab cardiotoxicity in patients with breast cancer |
| title_full_unstemmed | The role of cardiac biomarkers as predictors of trastuzumab cardiotoxicity in patients with breast cancer |
| title_short | The role of cardiac biomarkers as predictors of trastuzumab cardiotoxicity in patients with breast cancer |
| title_sort | role of cardiac biomarkers as predictors of trastuzumab cardiotoxicity in patients with breast cancer |
| topic | Original contributions |
| topic_facet | Original contributions |
| url | https://nasplib.isofts.kiev.ua/handle/123456789/145446 |
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