Cardio-oncology is at the intersection of cardiology and oncology, focusing
on an emerging dual mandate of optimizing outcomes in cancer therapies and
minimizing associated cardiovascular toxicity. The cardiovascular consequences of
cancer treatment include anthracyclines, trastuzumab, and checkpoint inhibitors,
covering the spectrum of asymptomatic myocardial injury through overt heart failure
and arrhythmias. These complications have a great impact on the quality of life and
survival of cancer patients, and thus, early identification and proactive management are
necessary. Robust serum biomarkers have become indispensable tools for risk
stratification, early diagnosis, and therapeutic monitoring, providing a non-invasive and
cost-effective approach to patient management. Traditional biomarkers, such as cardiac
troponins and natriuretic peptides, remain the mainstay for detecting myocardial injury
and cardiac dysfunction. Troponins are very sensitive and specific markers of acute and
cumulative cardiotoxic effects of therapies. Natriuretic peptides, including B-type
natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP), are important for the
diagnosis and monitoring of heart failure. However, these biomarkers are often unable
to detect subclinical cardiotoxicity or to fully capture the complex pathophysiological
mechanisms underlying cancer therapy-induced cardiac injury. In doing so, emergent
biomarkers have expanded the horizon of cardio-oncology beyond the earlier simplistic
diagnostic and prognostic limitations. Galectin-3 and soluble ST2, with their potential
roles in fibrosis and myocardial stress, indicate early stages of cardiac remodeling.
GDF-15, one of the related inflammation biomarkers, has become more useful in its
ability to forecast adverse cardiovascular consequences in cancer patients undergoing
cardiotoxic treatments. In addition, circulating microRNAs (miRNAs), small noncoding RNAs, have emerged as highly specific and sensitive indicators of myocardial stress and injury. Among these, miR-126, miR-208, and miR-34a are notably
interesting as they play roles in detecting subclinical cardiotoxicity and provide insight
into disease progression. Advances in proteomics, metabolomics, and multi-biomarker
panel technologies have further helped to enhance serum biomarkers. High-throughput
omics platforms also help in the discovery of previously uncharacterized biomarkers
and clarify the molecular mechanisms of cardiotoxicity.
Keywords: B-type natriuretic peptide, Cardiac biomarker, Cardiac troponins, Cardio-oncology, Cardiotoxicity, Cytokines, Tyrosine kinase inhibitor.
