Role of biomarkers in chemotherapy-induced cardiotoxicity

Chemotherapy-induced cardiotoxicity remains an unresolved problem strongly impacting the quality of life and the overall survival of cancer patients. The main strategy for minimizing cardiotoxicity is early detection of high-risk patients and prompt prophylactic treatment. The current standard for monitoring cardiac function detects cardiotoxicity only when a functional impairment has already occurred, not allowing for any early preventive strategies. Measurement of cardiospecific biomarkers can be a valid diagnostic tool for early identification, assessment, and monitoring of cardiotoxicity. In particular, the role of troponin in identifying patients at risk of cardiotoxicity and of angiotensin-converting enzyme inhibitors in preventing cardiac dysfunction and cardiac events is clearly emerging as a new effective approach. Therefore, we propose troponin as a criterion standard marker for the assessment of cardiac risk of both old and new antineoplastic treatments, and its evaluation should be included among the criteria utilized to define cardiotoxicity.