CARDIOPROTECTION takes centre stage as a new clinical trial reveals that a biomarker-guided strategy may modestly improve heart function in patients receiving anthracycline chemotherapy. The findings suggest that targeted monitoring could offer a feasible and safe route to early cardiac preservation.
Why Cardioprotection Matters in Anthracycline Therapy
Anthracyclines remain standard treatment for breast cancer and lymphoma, but their cardiotoxic potential is a longstanding concern. As a result, investigators explored whether cardioprotection guided by N-terminal pro B type natriuretic peptide (NT-proBNP G) could offer timely intervention during treatment. This approach aimed to address uncertainties around the real-world clinical actionability of cardiac biomarkers and to determine whether structured monitoring could influence outcomes.
Trial Evaluates NT-proBNP Guided Cardioprotection
The multicentre randomised trial enrolled 100 participants with a mean age of 52.2 years, of whom 86 were women. 74 participants had breast cancer and 26 had lymphoma. Individuals were randomised to either NT-proBNP-guided management or usual care and followed for 12 months. Retention at 12 months reached 92.7%, indicating strong feasibility. In the guided arm, 27 patients experienced biomarker elevations, with a median time to first elevation of 14 days and a median of 1 day to initiation or titration of neurohormonal therapy. Safety was comparable between groups, with 23 targeted adverse events in the guided arm and 16 in usual care. Notably, left ventricular ejection fraction at 3 months was modestly higher in the guided arm, with a mean difference of 2.0% and a 95% confidence interval of 0.5% to 3.5%. NT-proBNP concentrations rose in both groups but showed slightly reduced elevation in the guided cohort.
Implications for Clinical Practice
These findings suggest that biomarker-led cardioprotection is feasible, safe, and potentially effective at producing early improvements in cardiac function. Future clinical pathways may incorporate structured NT-proBNP monitoring to personalise cardiovascular support during cardiotoxic cancer therapy and reduce the risk of long-term cardiac impairment.
Reference
Xia C et al. Biomarker-guided cardioprotection for patients treated with anthracyclines: a randomized clinical trial. JAMA Netw Open. 2025;8(12):e2546201.
