Association of Biomarkers with Serious Cardiac Adverse Events during Abiraterone Acetate Treatment in Castration Resistant Prostate Cancer

Abstract

BACKGROUND: Abiraterone acetate is an effective drug for castration-resistant prostate cancer, but cardiac serious adverse events (SAEs) may occur. We studied their association with N-terminal pro–brain natriuretic peptide (NT-proBNP) and troponin T (TnT) during abiraterone therapy. PATIENTS AND METHODS: In a single institution, 17 patients were treated with abiraterone acetate 1 g daily with concomitant prednisone and then switched to dexametasone plus canrenone. Blood samples for PSA, NT-proBNP, and TnT were obtained at baseline and after 1, 3, and 6 months. RESULTS: Five patients (29.4%) experienced G3 to 4 cardiac SAEs after a median of 13 weeks (range, 9-32), including pulmonary edema, heart failure, acute coronary syndrome, sinus bradycardia with syncope, and pulmonary edema. At baseline, 4 weeks, and 3 months, median NT-proBNP and TnT levels were higher in patients with subsequent cardiac SAEs (P= .03 and P= .04 for NT-proBNP and TnT at 3 months, respectively). After switching to dexametasone and introducing canrenone, no additional cardiac SAEs were noted. Overall response rate was 67%. CONCLUSIONS: Our study suggests a higher than expected risk of cardiac SAEs during abiraterone treatment which may well be due to the small sample size and the unrestricted entry criteria. However, baseline and frequent NT-proBNP and TnT monitoring predicted a higher risk for cardiac SAE. Larger studies should confirm our findings.

Mortality and Hospitalization Risk Following Oral Androgen Signaling Inhibitors Among Men with Advanced Prostate Cancer by Pre-existing Cardiovascular Comorbidities

“…Our findings are consistent with published reports showing an increased risk of grade 3 (severe) or grade 4 (life-threatening) cardiac adverse events (AEs) after AA in the general population and clinical trials [20]. A meta-analysis of published randomized controlled trials found that AA was associated with a 2.2-fold risk of cardiovascular toxicity (RR = 2.2, 95% CI: 1.60-3.27); a similar pattern was not observed in ENZ users (RR = 1.32, 95% CI: 0.85-2.06) [21].…”

Role of Cardiac Biomarkers in Cancer Patients

“…In 2016 Campora et al found an association between higher levels of NT-proBNP and TnT dosed 3 months after initiation of abiraterone therapy and the incidence of severe cardiac adverse events [78].…”

Cardiac Biomarkers and Geriatric Assessment in Metastatic Castrate-Resistant Prostate Cancer During Abiraterone Acetate Therapy – A Cardio-Oncology Study

“…More CV events were reported in abnormal hsT and high NTproBNP groups. 38 In our study we draw a different hypothesis that cardiac biomarkers may predict superior response of AA treatment. In our research, D-dimer turned out to be the only marker with prognostic value and to our knowledge this is the first report of such correlation among mCRPC men treated with AA.…”