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High-sensitive troponin T assay can predict anthracycline- and trastuzumab-induced cardiotoxicity in breast cancer patients

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Abstract

Background

Trastuzumab following anthracycline causes cardiotoxicity in up to 28% of patients. Although the cardiotoxicity is often irreversible once cardiac dysfunction is detected, the early predictor has not been established yet.

Methods

We prospectively observed breast cancer patients treated with anthracycline or trastuzumab at Tonan Hospital. All patients underwent echocardiography and blood sampling at baseline, and every three months during chemotherapy. Cardiotoxicity was defined as a decline in left ventricular ejection fraction >10% points.

Results

Of 40 patients, 34 patients (85%) were treated with anthracycline (epirubicin), 18 (45%) with trastuzumab, and 12 (30%) with both agents. Cardiotoxicity was observed in four patients (10%), who were all treated with both agents. The absolute levels of high-sensitive troponin T (hs-TnT) were increased in all four patients with cardiotoxicity, and all the highest points were observed before or at the time of detection of cardiotoxicity. The highest level of hs-TnT was not significantly different in patients with and without cardiotoxicity. “Hs-TnT increment from baseline to the highest value” and “hs-TnT integration value above baseline” were significantly greater in patients with cardiotoxicity (0.039 vs. 0.007 ng/mL, P = 0.046, 0.113 vs. 0.022 ng months/mL, P = 0.013, respectively). The integration value had 100% sensitivity and specificity with a cutoff level at 0.070 ng months/mL.

Conclusions

Hs-TnT assay may be able to predict anthracycline- and trastuzumab-induced cardiotoxicity in breast cancer patients, and the hs-TnT increment or hs-TnT integration value above baseline was more reliable than the absolute value.

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Acknowledgements

The authors would like to thank the patients and ultrasonographers who participated in this study. We also thank Dr. Hiroyuki Shikishima for patient recruitment and follow-up, and Mr. David Hochman for reviewing the language of our article.

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Authors and Affiliations

  1. Department of Medical Oncology, Tonan Hospital, Kita 4 Nishi 7 3-8, Chuo-ku, Sapporo, Hokkaido, 060-0004, Japan

    Hiromitsu Kitayama, Tomohiro Kondo, Junko Sugiyama & Yasushi Tsuji

  2. Department of Clinical Laboratory, Tonan Hospital, Sapporo, Japan

    Kazutomo Kurimoto

  3. Department of Cardiovascular Medicine, Tonan Hospital, Sapporo, Japan

    Yasuhiro Nishino

  4. Department of Thoracic and Breast Surgery, Tonan Hospital, Sapporo, Japan

    Masaya Kawada

  5. Department of Gastroenterology, Tonan Hospital, Sapporo, Japan

    Michiaki Hirayama

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  1. Hiromitsu Kitayama
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  2. Tomohiro Kondo
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Correspondence to Hiromitsu Kitayama.

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12282_2017_778_MOESM1_ESM.tif

Timeline of high-sensitives cardiac troponin T level of each patient without cardiotoxicity (n =36). Median treatment and follow up time is 6 months (interquartile range, 3-12). Troponin level after three months from chemotherapy initiation is 0.013 ±0.0092 ng/mL (mean ±standard deviation), while integration value of the troponin level above baseline is <0.070 ng months/mL in every patient without cardiotoxicity (TIFF 1052 kb)

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Kitayama, H., Kondo, T., Sugiyama, J. et al. High-sensitive troponin T assay can predict anthracycline- and trastuzumab-induced cardiotoxicity in breast cancer patients. Breast Cancer 24, 774–782 (2017). https://doi.org/10.1007/s12282-017-0778-8

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  • DOI: https://doi.org/10.1007/s12282-017-0778-8

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