Researchers homing in on biomarkers for chemotherapy heart injury

Doxorubicin--often known by patients as "the red stuff"--is a common and effective treatment for breast cancer but can cause damage to the heart in a small group. Researchers at Ohio State University have started a study to find a way to identify these patients.

Doxorubicin acts on cancer by fitting itself (intercalating) into the DNA strand, stopping the cancer cells from replicating themselves. It can cause early heart damage a few days after treatment, but the more insidious side effect is the late heart damage, which happens a year or more after treatment, leading to congestive heart failure. Once this is picked up, it's too late--the damage is irreversible.

"Doxorubicin is one of the best drugs in breast cancer. But we've got to contend with this small, increased risk of heart damage. For those who develop problems, it's serious," said Dr. Charles Shapiro, director of breast medical oncology and leader of the breast cancer research program at the Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC-James).

In the study, the researchers will use high-definition cardiac MRI and frequent blood tests to try to find biomarkers that can spot heart damage earlier, allowing effective treatment and cessation of doxorubicin therapy. The research is focusing on the endothelial precursor cells, which are the cells that will become heart tissue. If these cells swell, it could be a sign of early damage from the doxorubicin.

The fact that this study is taking place at all is a testament to advances in the treatment of breast cancer, said Shapiro. Just a generation ago, doctors took a "kill the cancer first and foremost" approach to treating the disease. Today, survival rates have gone up so much that doctors are now treating patients with their long-term futures in mind, he said.

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