Troponin I and C-reactive protein are commonly detected in patients with breast cancer treated with dose-dense chemotherapy incorporating trastuzumab and lapatinib Journal Article


Authors: Morris, P. G.; Chen, C.; Steingart, R.; Fleisher, M.; Lin, N.; Moy, B.; Come, S.; Sugarman, S.; Abbruzzi, A.; Lehman, R.; Patil, S.; Dickler, M.; Mcarthur, H. L.; Winer, E.; Norton, L.; Hudis, C. A.; Dang, C.
Article Title: Troponin I and C-reactive protein are commonly detected in patients with breast cancer treated with dose-dense chemotherapy incorporating trastuzumab and lapatinib
Abstract: Purpose: There are no validated methods of early detection of cardiotoxicity from trastuzumab (T) following anthracycline-based chemotherapy. Currently changes in left ventricular ejection fraction (LVEF) are assessed but this approach has limited sensitivity and specificity. Within a prospective feasibility study of dose-dense (dd) doxorubicin and cyclophosphamide (AC) → weekly paclitaxel (P) with T and lapatinib (L), we included a preplanned analysis of correlative cardiac Troponin I (cTnI) and C-reactive protein (CRP) as early biomarkers of cardiotoxicity. Experimental Design: As previously described, patients received ddACx 4→PTL→TL. LVEF was assessed at months 0, 2, 6, 9, and 18 and cTnI and CRP measured every 2 weeks during chemotherapy then at months 6, 9, and 18. These biomarkers were correlated with changes in LVEF. Results: Ninety-five patients enrolled. Overall, 3 (3%) patients withdrew during AC and 41 (43%) withdrew during PTL→TL, mostly due to diarrhea. Median LVEF was 68% (baseline), 69% (month 2), 65% (month 6), 65% (month 9), and 65% (month 18). The majority (67%) had a detectable cTnI during the study. The proportion of detectable cTnIs increased over time; 4% at baseline, 11% at month 2, and 50% at month 3. The timing of these detectable cTnIs preceded maximum-recorded decline in LVEF. However, overall, maximum cTnI levels did not correlate with LVEF declines. A detectable CRP was seen in 74/95 (78%) but did not correlate with LVEF declines. Conclusion: In patients receiving ddAC→PTL, cTnIs are commonly detected. These elevations may precede changes in LVEF but, as assessed in this trial, do not predict CHF. ©2011 AACR.
Journal Title: Clinical Cancer Research
Volume: 17
Issue: 10
ISSN: 1078-0432
Publisher: American Association for Cancer Research  
Date Published: 2011-05-15
Start Page: 3490
End Page: 3499
Language: English
DOI: 10.1158/1078-0432.ccr-10-1359
PROVIDER: scopus
PUBMED: 21372222
DOI/URL:
Notes: --- - "Export Date: 23 June 2011" - "CODEN: CCREF" - "Source: Scopus"
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MSK Authors
  1. Sujata Patil
    383 Patil
  2. Patrick Glyn Morris
    107 Morris
  3. Clifford Hudis
    839 Hudis
  4. Larry Norton
    558 Norton
  5. Chau Dang
    156 Dang
  6. Maura N Dickler
    237 Dickler
  7. Richard M Steingart
    113 Steingart
  8. Carol Chen
    25 Chen
  9. Martin Fleisher
    236 Fleisher
  10. Robert James Lehman
    9 Lehman