Top Things to Know: Future Perspectives of Cardiovascular Biomarker Utilization in Cancer Survivors
Published: November 10, 2021
Prepared by Paul St. Laurent, DNP, RN, Sr. Science and Medicine Advisor, Lead
- This statement approaches a broad definition of the biomarker concept, summarizes the current literature on the use of established cardiovascular (CV) biomarkers at the intersection with cancer, identifies limitations and gaps regarding the use of biomarkers to stratify CV risk prior to cancer treatment, monitor CV health during cancer therapy, and detect latent CV damage in cancer survivors.
- This statement also highlights areas of research in biomarker discovery, validation, and clinical application for concerted efforts from funding agencies, scientists and clinicians at the cardio-oncology nexus.
- The development of novel cancer therapeutics has led to significant improvements in cancer survival, but CV complications pose a risk across all therapeutic classes, including conventional chemotherapy (e.g., anthracyclines), radiation, targeted therapies (e.g., multi-kinase inhibitors, monoclonal antibodies), and immunotherapies.
- Therapeutic protocols have different degrees of myocardial, vascular, arrhythmogenic, metabolic and immune toxicities with the potential risk of debilitating and even life-threatening cardiac events during therapy and following cancer remission.
- Objective measurement of physical, chemical or biological characteristics, termed biomarkers, reflect the interaction between biological systems and potential hazards.
- Useful biomarkers must be minimally affected by the cancer itself and reflect a person’s predisposing factors to the specific mechanism of cardiotoxicity, be sensitive to injury related to the oncological therapy but specific enough for levels not to be confounded by concurrent events such as comorbidities, and be consistently and strongly predictive of clinically significant short to intermediate-term CV outcomes.
- The use of biomarkers in cardio-oncology serve three main purposes: (1) enhance pre-therapy risk stratification, (2) detect subclinical evidence of cardiotoxicity during therapy, and (3) guide the long-term CV monitoring of cancer survivors.
- CV biomarkers have the potential for timely and accurate identification of cardiotoxicity and therefore can guide ongoing cancer therapy and optimize overall cancer survival after cancer diagnosis, enable early intervention to mitigate progressive and irreversible cardiac injury, and assign severity criteria for adverse events in clinical trials.
- The biomarkers discussed in this statement include those that measure exercise capacity, myocardial injury and left ventricular dysfunction, infiltrative cardiomyopathy, and immune therapy-related cardiotoxicity. In addition, novel biomarkers as well as the role of genomics, panomics, inducible pluripotent stem cells, and advanced CV imaging are reviewed.
- Improving cancer survival represents the most significant effect of precision medicine and personalized molecular and immunologic therapeutics which are known to adversely impact the CV system; thus CV health becomes a key determinant for the direction of overall outcomes after cancer.
Citation
Zaha VG, Hayek SS, Alexander KM, Beckie TM, Hundley WG, Kondapalli L, Ky B, Leger KJ, Meijers WC, Moslehi JJ, Shah SH; on behalf of the American Heart Association Cardio-Oncology Subcommittee of the Council on Clinical Cardiology; and Council on Genomic and Precision Medicine. Future perspectives of cardiovascular biomarker utilization in cancer survivors: a scientific statement from the American Heart Association [published online ahead of print November 10, 2021]. Circulation. doi: 10.1161/CIR.0000000000001032