Serum biomarkers are an important tool in the baseline risk assessment and diagnosis of cardiovascular disease in cancer patients receiving cardiotoxic cancer treatments. Increases in cardiac biomarkers including cardiac troponin and natriuretic peptides can be used to guide initiation of cardioprotective treatments for cancer patients during treatment and to monitor the response to cardioprotective treatments, and they also offer prognostic value. This position statement examines the role of cardiac biomarkers in the management of cancer patients. The Cardio-Oncology Study Group of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) in collaboration with the Cardio-Oncology Council of the ESC have evaluated the current evidence for the role of cardiovascular biomarkers in cancer patients before, during and after cardiotoxic cancer therapies. The characteristics of the main two biomarkers troponin and natriuretic peptides are discussed, the link to the mechanisms of cardiovascular toxicity, and the evidence for their clinical use in surveillance during and after anthracycline chemotherapy, trastuzumab and HER2-targeted therapies, vascular endothelial growth factor inhibitors, proteasome inhibitors, immune checkpoint inhibitors, cyclophosphamide and radiotherapy. Novel surveillance clinical pathways integrating cardiac biomarkers for cancer patients receiving anthracycline chemotherapy or trastuzumab biomarkers are presented and future direction in cardio-oncology biomarker research is discussed.

1st Department Medicine Cardioangiology Charles University Prague Medical Faculty and University Hospital Hradec Kralove Prague Czech Republic

Breast Unit Royal Marsden Hospital Surrey UK

Cardiac Department 'Guglielmo da Saliceto' Polichirurgico Hospital AUSL Piacenza Piacenza Italy

Cardio Oncology Center of Excellence Washington University in St Louis St Louis MO USA

Cardio Oncology Clinic Heart Failure Unit 'Attikon' University Hospital Athens Greece

Cardio Oncology Program Department of Medicine Vanderbilt University Medical Center Nashville TN USA

Cardio Oncology Service Royal Brompton Hospital and Imperial College London London UK

Cardiologist in Practice Turin Italy

Cardiology Division Internal Medicine Department at American University of Beirut Medical Center Beirut Lebanon

Cardiology Service Cardio Oncology Unit La Paz University Hospital and IdiPAz Research Institute Ciber CV Madrid Spain

Cardioncology Unit European Institute of Oncology IRCCS Milan Italy

Cardiovascular Research Institute Basel and Department of Cardiology University Hospital Basel University of Basel Basel Switzerland

Clinic of Cardiac and Vascular Diseases Institute of Clinical Medicine Faculty of Medicine Vilnius University Vilnius Lithuania

Comprehensive Heart Failure Center University Clinic Würzburg Würzburg Germany

Department of Cardiology and Pneumology University of Goettingen Medical Center Goettingen Germany

Department of Cardiology Bern University Hospital Inselspital University of Bern Bern Switzerland

Department of Cardiology Leiden University Medical Centre Leiden The Netherlands

Department of Cardiology Medical University of Vienna Vienna Austria

Department of Cardiology University of Groningen University Medical Center Groningen Groningen The Netherlands

Department of Community Cardiology Tel Aviv Jaffa District Clalit Health Fund and Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel

Department of Pharmacology Faculty of Medicine in Hradec Kralove Charles University Hradec Kralove Czech Republic

Department of Precision Medicine 'Luigi Vanvitelli' University of Campania Naples Italy

Department of Translational Medical Sciences and Interdepartmental Center for Clinical and Translational Research 'Federico II' University Naples Italy

Division of Cardiology and Metabolism Department of Cardiology Charité and Berlin Institute of Health Center for Regenerative Therapies partner site Berlin and Department of Cardiology Charité Campus Benjamin Franklin Berlin Germany

Duke Cancer Institute Duke University Durham NC USA

Edinburgh Heart Centre Royal Infirmary of Edinburgh Edinburgh UK

Emergency Institute for Cardiovascular Diseases 'Prof C C Iliescu' Bucharest Romania

Faculty of Medicine and Serbian Academy of Sciences and Arts University of Belgrade Belgrade Serbia

German Center for Cardiovascular Research partner site Goettingen Goettingen Germany

Inselspital University Hospital of Bern Bern Switzerland

MedStar Heart and Vascular Institute Georgetown University Washington DC USA

National and Kapodistrian University of Athens Medical School Athens Greece

Pharmacology Centre of Clinical and Experimental Medicine IRCCS San Raffaele Pisana Rome Italy

Sechenov Medical University Moscow Russia

State Research Institute Centre For Innovative Medicine Vilnius Lithuania

UMR S 942 Paris University Cardiology Department Lariboisiere Hospital AP HP Paris France

Université de Paris CIC1418 Paris Cardiovascular Research Center INSERM Paris France

University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland

University of Cyprus Medical School Nicosia Cyprus

University of Ljubljana Ljubljana Slovenia

University of Medicine Carol Davila Bucharest Romania

University of Pennsylvania Philadelphia PA USA

University of Warwick Warwick UK

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