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Biomarker-Guided Cardioprotection for Patients Treated With Anthracyclines: A Randomized Clinical Trial
Congying Xia1,2, Amanda M Smith1,2, Bénédicte Lefebvre1,2
1Division of Cardiology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
JAMA Network Open
|December 3, 2025
Summary
This study shows that guiding heart protection therapy with N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels is feasible and safe for cancer patients. This biomarker-guided approach may offer early improvements in left ventricular ejection fraction (LVEF).
Area of Science:
- Cardiology
- Oncology
- Biomarker Research
Background:
- Cardiotoxicity from anthracycline chemotherapy poses a significant risk to patients with breast cancer or lymphoma.
- Current methods for stratifying cardiovascular risk during chemotherapy have limitations.
- N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a potential biomarker for monitoring cardiac function.
Purpose of the Study:
- To evaluate the feasibility, safety, and exploratory efficacy of an NT-proBNP-guided strategy for cardioprotection in cancer patients receiving anthracyclines.
- To compare the NT-proBNP-guided approach with usual care in terms of neurohormonal therapy initiation and cardiac function.
Main Methods:
- A multicenter, randomized clinical trial (NT-proBNP guide) involving 100 patients with breast cancer or lymphoma treated with anthracyclines.
- Participants were randomized to either an NT-proBNP-guided arm with biomarker monitoring and tailored therapy or a usual care arm.
- Primary outcomes included feasibility (recruitment, retention, compliance) and safety (adverse events). Exploratory outcomes included echocardiographic measures and NT-proBNP levels.
Main Results:
- The study demonstrated high retention rates (92.7%) and feasible implementation of the NT-proBNP-guided approach.
- No significant differences in adverse events were observed between the guided and usual care arms.
- A modest but statistically significant improvement in left ventricular ejection fraction (LVEF) was noted at 3 months in the NT-proBNP-guided arm compared to usual care.
Conclusions:
- An NT-proBNP-guided strategy for initiating and adjusting neurohormonal therapy is feasible and safe in patients undergoing anthracycline chemotherapy.
- This biomarker-guided approach shows potential for early, modest improvements in cardiac function (LVEF).
- Further research is warranted to confirm the efficacy of NT-proBNP-guided cardioprotection in cancer patients.
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