SYSTEMATIC REVIEW article
Front. Cardiovasc. Med.
Sec. Cardio-Oncology
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1624023
This article is part of the Research TopicHeart Failure Induced by Non-Cardiac TherapiesView all 3 articles
Soluble suppression of tumorigenicity-2 (sST2) changes during cardiotoxic cancer treatment: a systematic review and meta-analysis
Provisionally accepted
Luca Fazzini1*
Simone Angius1
Nicola Campana1Luca Pascalis1
Martino Deidda1Giordano Maria Pugliesi2
Vincenzo Quagliariello3
Nicola Maurea3
Carlo Gabriele Tocchetti4
Pietro Ameri5
Christian Cadeddu Dessalvi1- 1University of Cagliari, Cagliari, Italy
- 2Mayo clinic, Rochester, United States
- 3Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Napoli, Italy
- 4Federico II University, Napoli, Italy
- 5IRCCS Ospedale Policlinico San Martino, Genova, Italy
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ABSTRACT Background. Soluble suppression of tumorigenicity-2 (sST2) is a promising biomarker of cardiovascular disease and heart failure. Data about the changes in sST2 concentrations during cancer treatment and the relationship with cancer treatment-related cardiotoxicity are sparse. Methods. We conducted a systematic review and meta-analysis to explore longitudinal changes in sST2 levels at three time points (T0 baseline, T1 post-chemotherapy, and T2 follow-up) in cancer patients treated with cardiotoxic therapies and compared these changes to traditional biomarkers of cardiac injury, i.e. troponin and NT-proBNP. Using random-effects models, mean differences (MD), and standardized MD (SMD), we analyzed (i) ST2 longitudinal changes, (ii) the association between ST2 and cardiotoxicity (defined through left ventricular ejection fraction (LVEF)) providing pooled estimates of correlations, and (iii) the SMD variations among biomarkers. Results. Eight studies were included, comprising 433 patients treated with anthracycline and/or HER2-directed antibodies. There was a trend toward increased sST2 levels from T0 to T2 (MD 1.86, 95% CI -0.97 to 4.68, p=0.200) and decreased levels from T1 to T2 (MD -1.96, 95% CI -4.28 to 0.37, p=0.100). A pooled analysis showed a negative correlation between sST2 levels and LVEF (r -0.29, 95% CI, -0.49- -0.05, p<0.010). Comparisons with Troponin and NT-proBNP showed a significantly higher Troponin SMD at T0-T1 (p=0.027), while no significant differences were observed for NT-proBNP. Conclusion. sST2 showed dynamic changes during cardiotoxic therapy correlating with cardiotoxicity. Troponin was demonstrated to have greater longitudinal variations. Further research is needed to evaluate longitudinal sST2 levels in patients who develop cardiotoxicity versus those who do not.
Keywords: Cardioncology, biomarker, ST2, Cardiotoxcity, Cardiotoxic adverse effect
Received: 06 May 2025; Accepted: 15 Oct 2025.
Copyright: © 2025 Fazzini, Angius, Campana, Pascalis, Deidda, Pugliesi, Quagliariello, Maurea, Tocchetti, Ameri and Cadeddu Dessalvi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Luca Fazzini, luca.fazzini10@gmail.com
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