9 THE ROLE OF SOLUBLE APOPTOTIC PROTEINS IN DETECTING ANTHRACYCLINE CARDIOTOXICITY

Aim To evaluate whether circulating soluble apoptosis-related protein levels change after anthracycline-containing chemotherapy and radiotherapy in relation to cardiac dysfunction or the applied treatment. Methods Circulating apoptotic proteins were determined with immunoassay in 40 breast cancer patients following surgery (T0), one month after epirubicin-based chemotherapy (T1) and one year later (T2). Chemotherapy, consisting of standard-dose (n=21) or high-dose myeloablative chemotherapy (n=19), preceded irradiation and tamoxifen. Circulating apoptotic proteins were compared with previous cardiac evaluations, including measurement of LVEF, B-type and N-terminal atrial natriuretic peptide (BNP and NT-ANP), diastolic function with echocardiography and a standard electrocardiogram. Results Soluble tumor necrosis factor receptor 1 (+ 30%), 2 (+ 43%) and Fas (+ 40%) were transiently increased at T1 compared to T0, whereas Fas ligand (- 64%) was transiently decreased, especially in the high-dose group. Apoptosis markers were not associated with cardiac dysfunction. Conclusions We observed interestingly significant, but transient changes in levels of soluble apoptotic proteins, particularly after high-dose chemotherapy. No relation was found between apoptosis-related proteins and standard markers of cardiotoxicity