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Circulating cardiovascular biomarkers could provide a sensitive, low\u2010cost solution. Biomarkers such as troponins, natriuretic peptides (NPs), novel upstream signals of oxidative stress, inflammation, and fibrosis as well as panomic technologies have shown substantial promise, and guidelines recommend baseline measurement of troponins and NPs in all patients receiving potential cardiotoxins. Nonetheless, supporting evidence has been hampered by several limitations. Previous reviews have provided valuable perspectives on biomarkers in cancer populations, but important analytic aspects remain to be examined in depth. This review provides comprehensive assessment of critical challenges and solutions in this field, with focus on analytical issues relating to biomarker measurement and interpretation. Examination of evidence pertaining to common and serious forms of cardiotoxicity reveals that improved study designs incorporating larger, more diverse populations, registry\u2010based approaches, and refinement of current definitions are key. Further efforts to harmonize biomarker methodologies including centralized biobanking and analyses, novel decision limits, and head\u2010to\u2010head comparisons are needed. Multimarker algorithms incorporating machine learning may allow rapid, personalized risk assessment. These improvements will not only augment the predictive value of circulating biomarkers in cardiotoxicity but may elucidate both direct and indirect relationships between cardiovascular disease and cancer, allowing biomarkers a greater role in the development and success of novel anticancer therapies.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.123.029574","type":"journal-article","created":{"date-parts":[[2023,10,27]],"date-time":"2023-10-27T14:07:22Z","timestamp":1698415642000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":51,"title":["Circulating Cardiovascular Biomarkers in Cancer Therapeutics\u2010Related Cardiotoxicity: Review of Critical Challenges, Solutions, and Future Directions"],"prefix":"10.1161","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-4900-3080","authenticated-orcid":false,"given":"Gillian","family":"Murtagh","sequence":"first","affiliation":[{"name":"Medical Affairs, Core Diagnostics Abbott Lake Forest IL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8338-1798","authenticated-orcid":false,"given":"James L.","family":"Januzzi","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine Massachusetts General Hospital, Harvard Medical School Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6375-9266","authenticated-orcid":false,"given":"Marielle","family":"Scherrer\u2010Crosbie","sequence":"additional","affiliation":[{"name":"Division of Cardiology The Hospital of the University of Pennsylvania Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1513-8833","authenticated-orcid":false,"given":"Tomas G.","family":"Neilan","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine Massachusetts General Hospital, Harvard Medical School Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9183-9340","authenticated-orcid":false,"given":"Susan","family":"Dent","sequence":"additional","affiliation":[{"name":"Duke Cancer Institute, Department of Medicine Duke University Durham NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7987-4768","authenticated-orcid":false,"given":"Jennifer E.","family":"Ho","sequence":"additional","affiliation":[{"name":"CardioVascular Institute and Division of Cardiology, Department of Medicine Beth Israel Deaconess Medicine Center Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinesh","family":"Appadurai","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine Northwestern University Feinberg School of Medicine Chicago IL USA"},{"name":"School of Medicine The University of Queensland St Lucia Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8952-4315","authenticated-orcid":false,"given":"Ray","family":"McDermott","sequence":"additional","affiliation":[{"name":"Medical Oncology St. Vincent\u2019s University Hospital Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9423-8578","authenticated-orcid":false,"given":"Nausheen","family":"Akhter","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine Northwestern University Feinberg School of Medicine Chicago IL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab674"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21565"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2013.48.7884"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.02.037"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2018-0157"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2020.01.072"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jeac106"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2015.09.015"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa052306"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.2016.018770"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2019.10.023"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jeu192"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(18)30457-1"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaccao.2019.08.004"},{"key":"e_1_3_1_16_2","unstructured":"National Library of Medicine . 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