N-Terminal Pro-Bnp Is A Possible Early Biomarker For The Cardiac Side-Effects Of Anthracyclines.

Anthracyclines (ACs) cause cardiac side-effects which may result in cardiomyopathy. Identification of early biomarkers for this condition is thus useful. The N-terminal split product of proBrain Natriuretic Peptide (Nt-pBNP) may be such a biomarker and was included in an exploratory study to identify biomarkers for the cardiac side-effects of ACs. Three groups were studied: patients who completed a full course of AC-based chemotherapy (group I), patients starting AC-based therapy (group II) and a group of gender, age and BMI-matched controls (group III). Blood samples were taken and ECG recordings made. For group I, measurements were done from ≈1 month after the completion of therapy and 3 times thereafter and compared with the controls from whom samples were collected once. In group II samples were drawn pre-dose, at cessation, and after 24 hrs for each course. Nt-pBNP was measured in duplicate using a competitive EIA. Statistical analysis included paired and non-paired t-test to detect differences between the time points and groups. Mean (SD) Nt-pBNP in the patients who completed AC-therapy was 754 (177) pmol/L which was higher (p<0.01) than in the controls 588 (80) pmol/L. There was a tendency for Nt-pro-BNP to slightly decline over time in group I but this was not significant (p=0.21). In group II Ntpro-BNP increased during the 1st AC course from 530 (54) pmol/L pre-dose to 612 (52) pmol/L (p<0.05) immediately post-dose and further to 789 (124) pmol/L at 24 hours (p=0.001). The pre-dose value before the 3rd AC course was 721 (115) pmol/L and thereby higher than the pre-dose value before the 1st AC course (p=0.01), and increased to a maximum 1019 (227) pmol/L (p<0.05). Nt-pBNP seems a promising biomarker for the cardiac effects of ACs and will be explored further. Clinical Pharmacology & Therapeutics (2004) 75, P59–P59; doi: 10.1016/j.clpt.2003.11.224