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Ponde, Noam; Bradbury, Ian; Lambertini, Matteo; Ewer, Michael; Campbell, Christine; Ameels, Helene; Zardavas, Dimitrios; Di Cosimo, Serena; Baselga, Jose; Huober, Jens; Izquierdo, Miguel; Fumagalli, Debora; Bozovic-Spasojevic, Ivana; Maetens, Marion; Harbeck, Nadia; Pusztai, Lajos; Berghorn, Michael; Im, Young-Hyuck; Ruiz Borrego, Manuel; Chen, Dar-Ren; Rodeheffer, Richard; Piccart, Martine; Suter, Thomas and Azambuja, Evandro de (2018): Cardiac biomarkers for early detection and prediction of trastuzumab and/or lapatinib-induced cardiotoxicity in patients with HER2-positive early-stage breast cancer: a NeoALTTO sub-study (BIG 1-06). In: Breast Cancer Research and Treatment, Vol. 168, No. 3: pp. 631-638

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Biomarkers of cardiac damages, such as troponin T (TnT) and the amino-terminal fragment of brain natriuretic peptide (NT-proBNP), may be useful as early predictors of cardiac dysfunction. The role of these biomarkers in patients receiving lapatinib and/or trastuzumab before anthracyclines is unknown. This study explores TnT and NT-proBNP as predictors of early cardiac toxicity in neoadjuvant breast cancer patients. This sub-study of the NEOALTTO trial tested if changes in the levels of TnT and NT-proBNP occurred after 2 weeks of anti-HER2 therapy (lapatinib, trastuzumab or their combination) alone and/or after 18 weeks of anti-HER2 therapy plus weekly paclitaxel. 173 and 172 were tested at all three timepoints for NT-proBNP and TnT, respectively. The incidence of biomarker elevation was overall low at all timepoints for all the three treatment arms. A total of 13 CEs in 11 patients occurred. Biomarker elevations in patients with CEs were very rare;only one patient with subsequent CE had a NT-proBNP elevation at baseline and at week 2. These results suggest that TnT and proBNP may not be useful as early predictors of cardiac toxicity in anthracycline-na < ve patients receiving trastuzumab and/or lapatinib.

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