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Tolmeijer SH, Boerrigter E, Schalken JA, Geerlings MJ, van Oort IM, van Erp NP, Gerritsen WR, Ligtenberg MJ, Mehra N. A Systematic Review and Meta-Analysis on the Predictive Value of Cell-Free DNA–Based Androgen Receptor Copy Number Gain in Patients With Castration-Resistant Prostate Cancer. JCO Precis Oncol 2020; 4:714-729. [DOI: 10.1200/po.20.00084] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE It has been suggested that androgen receptor copy number gain ( AR gain) detected in cell-free DNA (cfDNA) can predict treatment response to androgen receptor signaling inhibitors (ARSIs) in patients with castration-resistant prostate cancer (CRPC). But it is unclear whether cfDNA-based AR gain is a true resistance mechanism to ARSIs or mainly a reflection of the tumor burden. In this systematic review, we aim to summarize current literature and comment on the potential of cfDNA-based AR gain as a predictive biomarker to guide therapy choices. METHODS A literature search was conducted in PubMed/Medline, Cochrane, Embase, and Web of Science databases. Sixteen articles published before November 2019 were selected for the meta-analysis, representing more than 1,000 patients. By using a random effects model, the progression-free survival (PFS) and overall survival (OS) were compared between patients with and without cfDNA-based AR gain who had been treated with ARSIs or with taxane chemotherapy. RESULTS Upon treatment with ARSIs, the PFS (hazard ratio [HR], 2.33; 95% CI, 2.00 to 2.72; P < .0001) and the OS (HR, 3.83; 95% CI, 3.11 to 4.70; P < .0001) were worse for patients with cfDNA-based AR gain, independent of the line and type of ARSIs. The OS and PFS in patients treated with first-line docetaxel or second-line or third-line cabazitaxel seemed to be unaffected by AR gain, despite a higher disease burden in patients with AR gain. AR gain was associated with reduced response with later lines of docetaxel. CONCLUSION In patients with CRPC, cfDNA-based AR gain is associated with a worse response to ARSIs. The effect on patients who are receiving taxane chemotherapy seems to be dependent on the type and line, although data are limited. Future prospective studies are essential to assess the true potential of cfDNA-based AR gain as a minimally invasive biomarker to guide therapy choice.
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Affiliation(s)
- Sofie H. Tolmeijer
- Department of Medical Oncology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Emmy Boerrigter
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jack A. Schalken
- Department of Urology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Maartje J. Geerlings
- Department of Human Genetics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Inge M. van Oort
- Department of Urology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nielka P. van Erp
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Winald R. Gerritsen
- Department of Medical Oncology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marjolijn J.L. Ligtenberg
- Department of Human Genetics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Pathology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Niven Mehra
- Department of Medical Oncology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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López-Campos F, Linares-Espinós E, Maldonado Pijoan X, Sancho Pardo G, Morgan TM, Martínez-Ballesteros C, Martínez-Salamanca J, Couñago F. Genetic testing for the clinician in prostate cancer. Expert Rev Mol Diagn 2020; 20:933-946. [PMID: 32885704 DOI: 10.1080/14737159.2020.1816170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Prostate cancer (PCa) is one of the most common cancers worldwide and a leading cause of cancer-related mortality. Although the diagnosis and treatment of prostate cancer has improved substantially in recent years, new molecular biomarkers are needed to further prolong survival and improve the quality of life in these patients. AREAS COVERED This review analyzes the current evidence for prognostic and predictive molecular biomarkers that can be applied across different clinical scenarios, ranging from localized disease to metastatic castration-resistant PCa, with a particular emphasis on the biomarkers likely to become available in routine clinical practice in the near future. EXPERT OPINION There is a growing need for molecular testing to identify the most indolent types of prostate cancer to help optimize treatment strategies and spare treatment in these patients when possible. Current trends in the treatment of prostate cancer underscore the unmet clinical need for biomarkers to improve decision-making in a challenging clinical setting.
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Affiliation(s)
| | - Estefanía Linares-Espinós
- Urology Department, Hospital Universitario La Paz , Madrid, Spain.,Urology Department, Lyx Institute of Urology , Madrid, Spain.,Urology Department, Francisco De Vitoria University , Madrid, Spain
| | | | - Gemma Sancho Pardo
- Radiation Oncology Department, Hospital De La Santa Creu I Sant Pau , Barcelona, Spain
| | - Todd Mathew Morgan
- Urology Department. Michigan Center for Translational Pathology. Comprehensive Cancer Center, Cancer Center Floor B1 Reception C , Ann Arbor, MI, USA
| | - Claudio Martínez-Ballesteros
- Urology Department, Lyx Institute of Urology , Madrid, Spain.,Urology Department, Hospital Universitario Puerta De Hierro Majadahonda , Majadahonda, Spain
| | - Juan Martínez-Salamanca
- Urology Department, Lyx Institute of Urology , Madrid, Spain.,Urology Department, Francisco De Vitoria University , Madrid, Spain.,Urology Department, Hospital Universitario Puerta De Hierro Majadahonda , Majadahonda, Spain
| | - Felipe Couñago
- Radiation Oncology Department, Hospital Universitario Quirón Salud Madrid , Madrid, Spain.,Hospital de La Luz. Madrid.,Universidad Europea de Madrid
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