title: Using biomarkers to predict and to prevent cardiotoxicity of cancer therapy.
abstract: Cardiotoxicity is a common complication that may compromise the clinical effectiveness of anticancer therapy. The current standard for monitoring cardiac function detects cardiotoxicity only when a functional impairment has already occurred, not allowing for any early preventive strategy. Areas covered: A novel approach, based on the use of biomarkers has recently emerged, resulting in a very effective tool for early, real-time identiﬁcation, and monitoring of cardiotoxicity. In particular, cardiac troponin elevation during chemotherapy allows to identify patients more prone to develop myocardial dysfunction and cardiac events. In these patients, use of angiotensin-converting enzyme inhibitors, such as enalapril, has shown to be effective in improving clinical outcomes, giving the chance for cardioprotective strategies in a selected population. The authors reviewed the currently available data about the role of biomarkers in this setting. Expert commentary: Early identification of patients at high risk of cardiotoxicity by cardiac biomarkers - in particular troponin - provides a rationale for targeted preventive strategies against cancer therapy-induced left ventricular dysfunction and its associated clinical complications, with the advantage of limiting prophylactic therapy only to a restricted number of patients. Although the major international oncologic societies encourage this approach, some limitations to a routinely use of biomarkers still exist.
authors.affiliation: a Cardioncology Unit , European Institute of Oncology , IRCCS , Milan , Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Cardinale
authors.affiliation: a Cardioncology Unit , European Institute of Oncology , IRCCS , Milan , Italy.
authors.forename: Gina
authors.initials: G
authors.lastname: Biasillo
authors.affiliation: b Division of Laboratory Medicine , European Institute of Oncology , IRCCS , Milan , Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Salvatici
authors.affiliation: b Division of Laboratory Medicine , European Institute of Oncology , IRCCS , Milan , Italy.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Sandri
authors.affiliation: c Cardiology Department , European Institute of Oncology , IRCCS , Milan , Italy.
authors.forename: Carlo Maria
authors.initials: CM
authors.lastname: Cipolla
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D004656:Enalapril / Q000627:therapeutic use*; D006331:Heart Diseases / Q000097:blood / Q000139:chemically induced / Q000517:prevention & control; D006801:Humans; D009206:Myocardium / Q000378:metabolism; D009369:Neoplasms / Q000097:blood / Q000188:drug therapy*; D019209:Troponin C / Q000097:blood*
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000970:Antineoplastic Agents; D015415:Biomarkers; D019209:Troponin C; D004656:Enalapril
keywords: ACE-inhibitors; Cardiotoxicity; biomarkers; chemotherapy; natriuretic peptides; prevention; troponin