Table 3.
Role of BNP as a biomarker in the detection of cardiovascular toxicity of cancer therapeutics and immune therapies. This table summarises the studies demonstrating the value of BNP to detect cardiotoxicity including the type of cancer treatment, the characteristics of the cohort studied, percentage positive troponin at both baseline and after treatment, idenitification of the mechanisms involved to lead to cardiotoxicity, and the assay type and cut-off values used
| Treatment type | Reference | Patient cohort | Gender (male:female ratio) | Percentage of BNP positive (%) after treatment | Percentage of BNP positive (%) before treatment | BNP values | BNP cut-off (pg/mL) | BNP assay | Mechanism of cardiotoxicity |
|---|---|---|---|---|---|---|---|---|---|
| Anthracycline | Daugaard (2005) [84] | 107 patients, mean age 55 years with disseminated malignant disease treated with either doxorubicin or epirubicin | 22:85 | Not stated | N/A | Not stated | 0.5 pmol/L | Radio-immunoassay using rabbit antibodies and Sep-Pak C18 cartridges | Direct cardiotoxicity |
| Anthracycline | Lenihan (2016) [92] | 109 patients starting a new course of chemotherapy, median age 56 years | 52:57 48%:52% | Not stated | 1/109 (0.9%) | Not stated | 100 pg/mL | Not stated | Direct cardiotoxicity |
| Anthracycline | Hayakawa (2001) [96] | 34 patients who have received doxorubicin-containing chemotherapy | 18:16 | 8/34 (23.5%) | N/A | Not stated | Not stated | Not stated | Direct cardiotoxicity |
| Anthracycline | Lee (2008) [66] | 86 patients with mostly malignant lymphoma, mean age 48.5 years | 49:37 | Not stated | N/A | 305.8 pg/mL | 100 pg/mL | Triage® | Direct cardiotoxicity |
| Anthracycline | Palumbo (2016) [97] | 43 female patients with left-sided breast cancer, mean age 63 years | No males | Not stated | Not stated | 23.96 ± 15.08pg/mL at 1 month | 6.7 ± 18.6 pg/mL | Shinoria-BNP | Direct cardiotoxicity |
| Anthracycline | Kitayama (2017) [59] | 40 female breast cancer undergoing treatment with anthracycline or trastuzumab, aged 55–57 years | No males | No significant change from baseline | Not applicable | 20 ± 6 pg/mL | 18 ± 2.2 pg/mL (p = 0.7, not statistically significant change from baseline in BNP value) | BNP-JP Architect | Direct cardiotoxicity |
| Anthracycline | Sawaya (2011) [50] | 43 females with HER-2-positive breast cancer, age 48 | No males | No significant change from baseline | N/A | Not stated | NT-proBNP 125 pg/mL | Siemens Healthcare Diagnostics | Direct cardiotoxicity |
| Anthracycline | Mavinkurve-Groothuis (2013) [56] | 120 children | Not stated | 20% (8/41) | 26% (12/46) | Not stated | age-dependent reference vaues 97.5% percentile | Roche Diagnostics | Direct cardiotoxicity |
| Trastuzumab | Zardavas (2017) [55] | 102 females with HER-2-positive breast cancer after neoadjuvant chemotherapy, median 50 years | No males | Not stated | Not applicable | mean absolute increase in NT-pro BNP of 177 ng/L | Not stated | Elecsys NT-proBNP assay | Direct cardiotoxicity |
| Proteasome inhibitors | Cornell (2019) [98] | 95 patients with relapsed MM, (defined by International Myeloma Working Group) treated with carfilzomib- or bortezomib-based therapy, median age 66 years | 63:32 | Not stated | N/A | Median BNP rise 165 pg/mL, median NT-pro BNP 5925 pg/mL | BNP 100 pg/mL, NT-proBNP 125 pg/mL | Not stated | Direct cardiotoxicity |
| Vascular endothelial growth factor inhibitors | Catino (2018) [37] | 84 patients with metastatic renal cell carcinoma about to start sunitinib, median age 62.5 years | 56:28 | Not stated | N/A | Not stated | cut off not mentioned but BNP 31.7 pg/mL at baseline | Singulex single molecule counting assay | Direct cardiotoxicity |