THE TROPONIN PROGNOSTIC CAPABILITY IN DIAGNOSINGCARDIOTOXICITY DURING CHEMOTHERAPY WITH ANTHRACYCLINESAND MONOCLONAL ANTIBODIES IN BREAST CANCER PATIENTS

Abstract

Introduction. Breast cancer is sensitive to some schemes of chemotherapy known to be aggressive towards the
cardiovascular system. There is anthracycline-mediated irreversible cardiotoxicity of the first type and trastuzumab-mediated
reversible cardiotoxicity of the second type. The use of serum biomarkers capable of detecting myocardial injury before
symptoms appear is an alternative approach to early diagnosis of the chemotherapy cardiotoxic complications.
Aim: analyze the prognostic value of troponin for the early detection of cardiotoxic complications caused by
anthracycline and/or trastuzumab in breast cancer patients.
Search strategy: The search was carried out across the databases Pubmed, Web of Science, Scopus, e-LIBRARY.
Criteria for inclusion in the review were: randomized controlled trials and prospective studies dated 2010–2020. The
keywords were used according to the following sections: pathology: "breast cancer", "breast"; treatment: «anthracyclines»,
«trastuzumab», «chemotherapy»; biomarkers: «troponin», «troponin I», «troponin T», «high sensitive troponin»;
complications of chemotherapy: "cardiotoxicity", studies: "controlled trial", "randomized controlled trial", "controlled clinical
trial", "clinical trial". The selection of studies was carried out by the triangulation method. In total, the review included full-text
27 studies that completely met the search criteria. The list of references also contains researches that did not meet the
search criteria, but illustrating the relevance of the topic.
Results. An increase in troponin levels may signify the development of cardiac dysfunction with a poor prognosis,
especially if troponin levels continue to rise. The increase in the hs-troponin and the integral of the increase are more reliable
predictors than the absolute value of troponin.
Сonclusions. Breast cancer patients receiving anthracyclines and subsequent targeted chimiotherapy have the highest
risk of cardiotoxic complications. Troponin level monitoring has predictive potential and should be considered to all patients
receiving chemotherapy. Troponin and the combination of several markers may turn out to be more sensitive in predicting
cardiotoxicity in patients treated with anthracyclines and trastuzumab.