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Use of N-Terminal Pro-Brain Natriuretic Peptide to Assess Left Ventricular Function after Adjuvant Doxorubicin Therapy in Early Breast Cancer Patients

A Prospective Series

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Abstract

Background and objective: Anthracyclines are well established and highly efficacious antineoplastic agents for various haematopoietic and solid tumours, such as breast cancer. The main adverse effect of anthracycline therapy is cardiotoxicity. The aim of this prospective study was to determine the role of plasma levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) in assessing left ventricular function in early breast cancer patients receiving adjuvant anthracycline treatment.

Methods: Thirty-three newly diagnosed breast cancer patients who received a total doxorubicin dosage of 240 mg/m2 over four treatment cycles as part of adjuvant chemotherapy after curative breast surgery were included in this study. Venous NT-proBNP levels were measured before and at the end of doxorubicin therapy. Left ventricular function was measured by echocardiography conducted 3 weeks after surgery and at the end of doxorubicin therapy.

Results: NT-proBNP levels were significantly higher in patients (n = 10) with decreased left ventricular ejection fraction (LVEF) [p = 0.02]. There was no difference in LVEF (p = 0.164) or NT-proBNP levels (p = 0.844) between the patients who had high NT-proBNP levels and those who had normal NT-proBNP levels before doxorubicin chemotherapy. None of the factors studied (breast cancer grade, estrogen receptor status, progesterone receptor status, human epidermal growth factor receptor 2 status, age) was found to be significantly related to NT-proBNP.

Conclusion: The association between higher NT-proBNP levels and reduced LVEF in asymptomatic breast cancer patients after doxorubicin administration could be an early indication of subclinical acute anthracycline cardiotoxicity. Furthermore, breast cancer patients experiencing a progressive increase in NT-proBNP levels might be in a higher risk group for acute anthracycline cardiotoxicity.

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Acknowledgements

No sources of funding were used to assist in the preparation of this study. The authors have no conflicts of interest that are directly relevant to the content of this study.

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Authors and Affiliations

  1. Department of Medical Oncology, Faculty of Medicine, Dicle University, Diyarbakir, 21280, Turkey

    Timucin Cil & Abdurrahman Isikdogan

  2. Department of Internal Medicine, Faculty of Medicine, Dicle University, Diyarbakir, Turkey

    Ali M. Kaplan

  3. Department of Haematology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey

    Abdullah Altintas

  4. Department of Cardiology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey

    Ata M. Akin & Sait Alan

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  1. Timucin Cil
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  2. Ali M. Kaplan
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  3. Abdullah Altintas
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  4. Ata M. Akin
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  6. Abdurrahman Isikdogan
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Correspondence to Timucin Cil.

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Cil, T., Kaplan, A.M., Altintas, A. et al. Use of N-Terminal Pro-Brain Natriuretic Peptide to Assess Left Ventricular Function after Adjuvant Doxorubicin Therapy in Early Breast Cancer Patients. Clin. Drug Investig. 29, 131–137 (2009). https://doi.org/10.2165/0044011-200929020-00007

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