Kittiwarawut Annop, Vorasettakarnkij Yongkasem, Tanasanvimon Suebpong, Manasnayakorn Sopark, Sriuranpong Virote
Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Asia Pac J Clin Oncol. 2013 Jun;9(2):155-61. doi: 10.1111/j.1743-7563.2012.01588.x. Epub 2012 Aug 16.
Cardiac dysfunction is a major limitation of anthracycline treatment in cancer patients. There are several useful serum markers in other types of cardiomyopathy, including N-terminal pro-brain-natriuretic peptide (NT-proBNP), troponin-T and creatine kinase MB isoform. We investigated the potential application of these serum biomarkers in cancer patients receiving treatment with anthracycline.
We collected data from 52 female breast cancer patients receiving doxorubicin and cyclophosphamide every 3 weeks for four cycles. Cardiac function evaluations by echocardiography were done at baseline and at the end of the fourth cycle of chemotherapy. Patients' blood samples were serially measured for cardiac biomarkers.
The mean cumulative dose of doxorubicin in this study was 237 mg/m(2) . No symptomatic heart failure was detected during the study period. However, there were significant asymptomatic reductions of left ventricular ejection fraction (LVEF) from mean ± SD 70.7 ± 6% at baseline to 67.0 ± 5% (P < 0.001). By clinical toxicity criteria the LVEF decline was grade I in 18% and grade II in 4%. After one dose of chemotherapy, a significant rise of serum NT-proBNP occurred in patients who subsequently developed an LVEF reduction compared with patients with normal LVEF (P = 0.04). A correlation analysis demonstrated that the reduction of fractional shortening was significantly associated with elevated NT-proBNP (r = -0.016, P = 0.014).
Asymptomatic reductions in cardiac function are common in breast cancer patients treated with doxorubicin. NT-proBNP may serve as a convenient serum biomarker for the early detection of cardiotoxicity induced by anthracycline.
心脏功能障碍是癌症患者蒽环类药物治疗的主要限制因素。在其他类型的心肌病中有几种有用的血清标志物，包括N末端脑钠肽前体（NT-proBNP）、肌钙蛋白T和肌酸激酶MB同工酶。我们研究了这些血清生物标志物在接受蒽环类药物治疗的癌症患者中的潜在应用。
我们收集了52例女性乳腺癌患者的数据，这些患者每3周接受一次阿霉素和环磷酰胺治疗，共四个周期。在基线和化疗第四周期结束时通过超声心动图进行心脏功能评估。对患者的血样进行连续的心脏生物标志物检测。
本研究中阿霉素的平均累积剂量为237mg/m²。研究期间未检测到有症状的心衰。然而，左心室射血分数（LVEF）有显著的无症状降低，从基线时的平均±标准差70.7±6%降至67.0±5%（P<0.001）。根据临床毒性标准，LVEF下降为I级的占18%，II级的占4%。一剂化疗后，与LVEF正常的患者相比，随后出现LVEF降低的患者血清NT-proBNP显著升高（P=0.04）。相关性分析表明，缩短分数的降低与NT-proBNP升高显著相关（r=-0.016，P=0.014）。
接受阿霉素治疗的乳腺癌患者心脏功能无症状降低很常见。NT-proBNP可作为一种方便的血清生物标志物，用于早期检测蒽环类药物引起的心脏毒性。
