By using a blend of high definition cardiac imaging and biomarkers, Ohio State University cancer and heart researchers think they may have a way to catch early heart damage caused by anthracyclines, a class of chemotherapy drugs commonly used to treat breast and childhood cancers.
Presented at the recent San Antonio Breast Cancer Symposium, and funded by the Ohio State Center for Clinical and Translational Science (CCTS), the study looked at breast cancer patients being treated with doxorubicin, a type of anthracycline that is effective at treating breast cancer, but may lead to future heart problems in some women long after the treatment is complete.
"Currently, we are unable to predict who is more likely to develop heart problems, and we usually only catch the damage once it's too late." said Dr. Maryam Lustberg, a breast oncologist at the Ohio State University Comprehensive Cancer Center -- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC-James). "If we could identify these at-risk patients earlier, we could introduce cardio-protective drugs or eliminate cardio-toxic drugs."
The study honed in on measuring epithelial progenitor cells (EPCs) -- a rare cell type found in the bloodstream that can indicate cardiac reserve, a measure of how resilient the heart can be in recovering from various insults. EPC levels are a well-established predictor of outcomes in patients with heart attacks or heart disease, but the researchers are the first to explore their use in predicting which chemotherapy patients may be at highest risk for developing cardiac injury after exposure to anthrcyclines.
In addition to looking at EPCs, researchers analyzed heart function and physical changes to the heart using cardiac magnetic resonance imaging (CMR), as well as measuring blood levels of troponin and BNP, two biomarkers that indicate cardiac damage. Measurements were taken before, during and after the course of treatment, which for breast cancer patients, typically lasts about two months.
Researchers found that patients who came in with lower EPCs were more likely to have higher levels of troponin in their blood by the end of treatment. While the treatment was well-tolerated, and there were no acute indications of damage to heart function, the researchers also identified a trend in physical changes in the heart, including increased water content in heart cells and indications that the heart was working less efficiently.
Dr. Subha Raman a cardiologist and professor of cardiovascular medicine at Ohio State's Wexner Medical Center noted, "By pairing CMR with measuring the amount of chemical messengers in the blood stream, we're building a solid foundation that may help us develop a predictive model in the future."
The researchers plan to reassess patients at 12 and 24 months, and hope to follow the study group for as long as five years in order to capture more data.
"This kind of research is a testament to the fact that survival rates after a cancer diagnosis have never been higher. We want to make sure that life after cancer treatment is as healthy as possible," said Lustberg.
Materials provided by Ohio State University Center for Clinical and Translational Science. Note: Content may be edited for style and length.
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