Cardiac biomarker changes with neoadjuvant epirubicin-based chemotherapy

Aim: A major concern with epirubicin-based neoadjuvant chemotherapy, a mainstay of neoadjuvant treatment for breast cancer in Nigeria, is their association with cardiotoxicity. We investigated for possible changes in the level of cardiac markers, troponin T, and N-terminal pro-brain natriuretic peptide (NT-ProBNP) detectable after least three cycles of epirubicin in the neoadjuvant setting. Methods: Thirty consenting female patients who had received at least three cycles of epirubicin-based neoadjuvant chemotherapy were recruited from the Surgical Oncology Unit of the University College Hospital. Patients who were eligible for neoadjuvant chemotherapy for breast cancer but who had not commenced the same were recruited to serve as controls. Samples for troponin T and NT-ProBNP were collected on the day of commencement of the next cycle, before the administration of the dose. Results: The mean troponin T and median NT-ProBNP values were significantly higher among the women on epirubicin-based chemotherapy (0.76 ng/ml vs. 0.68 ng/ml, P = 0.047 and 114.5 pg/ml vs. 103 pg/ml, P = 0.007), respectively. Values of NT-ProBNP exceeding 200 pg/ml were significantly more frequently observed in the same group (40% vs. 16.7%, P = 0.01). A significant relationship between the number of cycles received and level of NT-ProBNP was observed (P = 0.015). A similar relationship was not observed with troponin T. Conclusion: Epirubicin-based chemotherapy may be associated with increased elaboration of the cardiac markers, NT-ProBNP, and troponin T early during neoadjuvant chemotherapy. The potential clinical utility of these markers in predicting cardiotoxicity needs to be further evaluated in prospective studies.