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

Abstract

Background Abiraterone acetate (AA) is a drug used in advanced prostate cancer. However, known clinical factors with predictive and prognostic value are scarce. This study evaluated cardiovascular (CV) factors and geriatric scales as potential markers of superior response during AA therapy. Methods This is a prospective observational study. Serum levels of high sensitivity troponin T (hsTnT), D-dimer, NT-proBNP and left ventricle ejection fraction (LVEF) were used for CV evaluation. Questionnaires of G8, VES-13, Activities of Daily Living (ADL), Instrumental Activities of Daily Living (iADL), and Geriatric Depression Scale (GDS) were included in the geriatric screening assessment. All measures were taken before AA initiation. Survival curves and Cox proportional hazard models (univariate and multivariate) were used to determine the predictors for a longer time to treatment failure (TTF). Results Forty nine patients were included in the study. Overall median TTF was 7.9 months (95% CI: 5.9-12.4). In univariate analysis, factors associated with inferior TTF were ( P-value < .05): visceral metastases - HR 2.34; 95% CI: 1.24-4.45, history of coronary artery disease - HR 3.02; 95% CI: 1.19-7.66; LVEF < 50% - HR 2.53; 95% CI: 1.03-6.17; P = .041; age-adjusted D-dimer > upper reference limit (URL) - HR 3.53; 95% CI: 1.81-6.85; P < .001; hsTnT > URL - HR 2.17; 95% CI: 1.13-4.16; P = .016; NT-proBNP ≥ 300 pg/mL - HR 2.3; 95% CI: 1.22-4.34; P = .01; G8 score ≤14 points - HR 2.47; 95% CI: 1.29-4.74; P = .007. In multivariate analysis, age-adjusted D-dimer > URL, G8 score ≤ 14 points and visceral metastases remained statistically significant in prediction of inferior TTF. The number of these factors was associated with shorter median TTF: 0-1 factor – 14.1 months; 2 factors – 5.9 months; 3 factors – 2.7 months; P < .001, log-rank). Conclusions Age-adjusted D-dimer, and geriatric G8 scores may predict TTF in men with metastatic castration-resistant prostate cancer during AA therapy. These observations require further study in a larger population.

The usefulness of left and right ventricular GLS assessment and biomarker concentrations in cardiovascular risk stratification in patients qualified for hematopoietic stem cell transplantation due to hematopoietic and lymphoid malignancies – a pilot study description

“…Based on the previous cardio-oncology experience in lung and prostate cancer, we can con rm the prognostic and predictive value of classic cardiac biomarkers (D-dimer, NT-proBNP, troponin) and modern echocardiography parameters such as GLS of the left and right ventricle [14][15][16][17]. After conducting this pilot study, we can create a predictive and prognostic model for patients undergoing HSCT.…”

The Vulnerable Elders Survey-13 (VES-13) scale is superior to sPESI in predicting 3-month post-discharge mortality in elderly survivors of acute pulmonary embolism

“…CGA is the gold standard for identifying and managing health conditions among geriatric patients, not only with neoplastic but also with CVD. 48 CGA mediated by the initial VES-13 evaluation may be a useful strategy for health care system physicians. As the geriatric assessment is time-consuming and comprises many tests, we propose a compact approach consisting of the VES-13 in the first step and NSS that may be useful in daily clinical practice to identify patients at a higher risk of 3-month mortality.…”