Next-Generation Biomarkers in Cardio-Oncology: Translating Multi-Omics Research into Clinical Practice

Cardiovascular complications remain a major cause of morbidity and mortality among cancer survivors. While conventional biomarkers such as cardiac troponins and natriuretic peptides have significantly improved the detection of cancer therapy-related cardiovascular toxicity (CTR-CVT), their ability to identify subclinical injury and predict long-term outcomes remains limited. Recent advances in multi-omics technologies, including genomics, transcriptomics, proteomics, metabolomics, epigenomics, and microbiomics, have transformed biomarker discovery in cardio-oncology. These next-generation biomarkers provide mechanistic insights into the molecular pathways underlying cardiotoxicity and offer opportunities for personalized risk stratification, early diagnosis, and therapeutic intervention. Emerging molecular signatures, including circulating microRNAs, extracellular vesicles, cell-free DNA, protein panels, metabolic fingerprints, and epigenetic markers, have demonstrated considerable promise for identifying cardiovascular injury before overt functional decline occurs. Integration of multi-omics datasets with artificial intelligence and machine learning approaches further enables the development of predictive models capable of supporting precision cardio-oncology. This review summarizes recent advances in next-generation biomarkers, highlights their clinical applications, discusses current challenges in translation, and explores future directions toward personalized cardiovascular monitoring and management in cancer patients