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High-sensitivity cardiac troponin I detection for 2 types of drug-induced cardiotoxicity in patients with breast cancer

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Abstract

Background

Breast cancer treatment with trastuzumab, a monoclonal antibody that targets human epidermal growth factor receptor type 2 (HER2), has largely been successful in improving the prognosis of HER2-positive disease. However, a critical issue associated with trastuzumab treatment is its cardiotoxic adverse effects, including cardiac insufficiency.

Methods

We measured levels of cardiac troponin I, a marker of myocardial damage, with a highly sensitive method (hs-cTnI) using a fully automated chemiluminescent immunoassay system (ADVIA Centaur® XP) in breast cancer patients and examined the relationship between administration of trastuzumab and epirubicin and concentrations of hs-cTnI.

Results

The coefficient of variation for within-run repeatability was 1.34–5.93 %, using plasma pools and controls of 3 concentrations, and that for between-run reproducibility was 3.99–8.79 %, indicating high precision of the assay. In a dilutional linearity test with highly concentrated specimens, hs-cTnI values could be measured up to 50 ng/mL with linearity. No influence from coexisting substances was observed. The concentration of hs-cTnI was at or above the reference range (0.04 ng/mL) in 9 of 214 total breast cancer cases (4.2 %). The hs-cTnI concentration was at or above the reference range in 4 of 49 cases (8.2 %) that were administered trastuzumab, and in 5 of 165 cases (3.0 %) that were not. Trastuzumab did not cause elevation of hs-cTnI when not administered in combination with epirubicin.

Conclusions

These results suggest that epirubicin and trastuzumab cause cardiotoxicity through different mechanisms. Epirubicin can cause myocardial necrosis, while trastuzumab can cause cardiomyopathy without myocardial necrosis.

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Conflict of interest

None declared.

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Authors and Affiliations

  1. Department of Clinical Laboratory, Tokai University Hospital, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan

    Seiichi Mokuyasu

  2. Graduate School of Health Sciences, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa, 920-0942, Japan

    Seiichi Mokuyasu & Ei Kawahara

  3. Department of Breast and Endocrine Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan

    Yasuhiro Suzuki & Yutaka Tokuda

  4. Department of Clinical Laboratory, Tokai University OISO Hospital, 21-1 Gakkyo, Oiso, Naka, Kanagawa, 259-0198, Japan

    Takayuki Seto

Authors
  1. Seiichi Mokuyasu
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  2. Yasuhiro Suzuki
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Correspondence to Seiichi Mokuyasu.

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Mokuyasu, S., Suzuki, Y., Kawahara, E. et al. High-sensitivity cardiac troponin I detection for 2 types of drug-induced cardiotoxicity in patients with breast cancer. Breast Cancer 22, 563–569 (2015). https://doi.org/10.1007/s12282-014-0520-8

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  • DOI: https://doi.org/10.1007/s12282-014-0520-8

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