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Saad F, Armstrong AJ, Oya M, Vianna K, Özgüroğlu M, Gedye C, Buchschacher GL, Lee JY, Emmenegger U, Navratil J, Virizuela JA, Salazar A, Maillet D, Uemura H, Kim J, Oscroft E, Barker L, Degboe A, Clarke NW. Tolerability of Olaparib Combined with Abiraterone in Patients with Metastatic Castration-resistant Prostate Cancer: Further Results from the Phase 3 PROpel Trial. Eur Urol Oncol 2024:S2588-9311(24)00082-8. [PMID: 38582650 DOI: 10.1016/j.euo.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/14/2024] [Accepted: 03/11/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND The PROpel study (NCT03732820) demonstrated a statistically significant progression-free survival benefit with olaparib plus abiraterone versus placebo plus abiraterone in the first-line metastatic castration-resistant prostate cancer (mCRPC) setting, irrespective of homologous recombination repair mutation status. OBJECTIVE We report additional safety analyses from PROpel to increase clinical understanding of the adverse-event (AE) profiles of olaparib plus abiraterone versus placebo plus abiraterone. DESIGN, SETTING, AND PARTICIPANTS A randomised (1:1), double-blind, placebo-controlled trial was conducted at 126 centres in 17 countries (October 2018-January 2020). Patients had mCRPC and no prior systemic mCRPC treatment. INTERVENTION Olaparib (300 mg bid) or placebo with abiraterone (1000 mg od) plus prednisone/prednisolone (5 mg bid). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The data cut-off date was July 30, 2021. Safety was assessed by AE reporting (Common Terminology Criteria for Adverse Events v4.03) and analysed descriptively. RESULTS AND LIMITATIONS The most common AEs (all grades) for olaparib plus abiraterone versus placebo plus abiraterone were anaemia (46.0% vs 16.4%), nausea (28.1% vs 12.6%), and fatigue (27.9% vs 18.9%). Grade ≥3 anaemia occurred in 15.1% versus 3.3% of patients in the olaparib plus abiraterone versus placebo plus abiraterone arm. The incidences of the most common AEs for olaparib plus abiraterone peaked early, within 2 mo, and were managed typically by dose modifications or standard medical practice. Overall, 13.8% versus 7.8% of patients discontinued treatment with olaparib plus abiraterone versus placebo plus abiraterone because of an AE; 3.8% versus 0.8% of patients discontinued because of anaemia. More venous thromboembolism events were observed in the olaparib plus abiraterone arm (any grade, 7.3%; grade ≥3, 6.8%) than in the placebo plus abiraterone arm (any grade, 3.3%; grade ≥3, 2.0%), most commonly pulmonary embolism (6.5% vs 1.8% for olaparib plus abiraterone vs placebo plus abiraterone). CONCLUSIONS Olaparib plus abiraterone has a manageable and predictable safety profile. PATIENT SUMMARY The PROpel trial showed that in patients who had not received any previous treatment for metastatic castration-resistant prostate cancer, olaparib combined with abiraterone was more effective in delaying progression of the disease than abiraterone alone. Most side effects caused by combining olaparib with abiraterone could be managed with supportive care methods, by pausing olaparib administration for a short period of time and/or by reducing the dose of olaparib.
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Affiliation(s)
- Fred Saad
- Centre Hospitalier de l'Université de Montréal/CRCHUM, Université de Montréal, Montreal, QC, Canada.
| | - Andrew J Armstrong
- Duke Cancer Institute Center for Prostate and Urologic Cancer, Duke University, Durham, NC, USA
| | | | - Karina Vianna
- Centro Integrado de Oncologia de Curitiba, Curitiba, Brazil
| | - Mustafa Özgüroğlu
- Istanbul University Cerrahpaşa, Faculty of Medicine, Istanbul, Türkiye
| | - Craig Gedye
- Calvary Mater Newcastle, Waratah, NSW, Australia
| | | | - Ji Youl Lee
- The Catholic University of Korea Seoul St Mary's Hospital, Seoul, South Korea
| | | | - Jiri Navratil
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | | | | | - Denis Maillet
- Centre Hospitalier Lyon Sud, Pierre-Bénite, France; Faculté de Médecine Jacques Lisfranc, Saint-Etienne, France
| | - Hiroji Uemura
- Yokohama City University Medical Center, Kanagawa, Japan
| | - Jeri Kim
- Merck & Co., Inc., Rahway, NJ, USA
| | | | | | | | - Noel W Clarke
- The Christie and Salford Royal Hospital NHS Foundation Trusts, and University of Manchester, Manchester, UK
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2
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Deek MP, Sutera P, Jing Y, Gao R, Rothman E, Day H, Chang D, Dirix P, Armstrong AJ, Campbell B, Campos FL, Berenguer M, Ramotar M, Conde-Moreno A, Berlin A, Bosetti DG, Corcoran N, Koontz B, Mercier C, Siva S, Pryor D, Ost P, Huynh MA, Kroeze S, Stish B, Kiess A, Trock B, Tran PT, Gillessen S, Sweeney C. Multi-institutional Analysis of Metastasis-directed Therapy with or Without Androgen Deprivation Therapy in Oligometastatic Castration-sensitive Prostate Cancer. Eur Urol Oncol 2024:S2588-9311(24)00086-5. [PMID: 38570239 DOI: 10.1016/j.euo.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/10/2024] [Accepted: 03/19/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Metastasis-directed therapy (MDT) is increasingly being used in oligometastatic castration-sensitive prostate cancer (omCSPC). However, it is currently unclear how to optimally integrate MDT with the standard of care of systemic hormonal therapy. OBJECTIVE To report long-term outcomes of MDT alone versus MDT and a defined course of androgen deprivation therapy (ADT) in omCSPC. DESIGN, SETTING, AND PARTICIPANTS Here, a multicenter, international retrospective cohort of omCSPC as defined by conventional imaging was reported. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Biochemical progression-free survival (bPFS), distant progression-free survival (dPFS), and combined biochemical or distant progression-free survival (cPFS) were evaluated with Kaplan-Meier and multivariable Cox proportional hazard regression models. RESULTS AND LIMITATIONS A total of 263 patients were included, 105 with MDT + ADT and 158 with MDT alone. The majority of patients had metachronous disease (90.5%). Five-year bPFS, dPFS, and cPFS were, respectively, 24%, 41%, and 19% in patients treated with MDT + ADT and 11% (hazard ratio [HR] 0.48, 95% confidence interval [CI] 0.36-0.64), 29% (HR 0.56, 95% CI 0.40-0.78), and 9% (HR 0.50, 95% CI 0.38-0.67) in patients treated with MDT alone. On a multivariable analysis adjusting for pretreatment variables, the use of ADT was associated with improved bPFS (HR 0.43, p < 0.001), dPFS (HR 0.45, p = 0.002), and cPFS (HR 0.44, p < 0.001). CONCLUSIONS In this large multi-institutional report, the addition of concurrent ADT to MDT appears to improve time to prostate-specific antigen progression and distant recurrence, noting that about 10% patients had durable control with MDT alone. Ongoing phase 3 studies will help further define treatment options for omCSPC. PATIENT SUMMARY Here, we report a large retrospective review evaluating the outcomes of metastasis-directed therapy with or without a limited course of androgen deprivation for patients with oligometastatic castration-sensitive prostate cancer. This international multi-institutional review demonstrates that the addition of androgen deprivation therapy to metastasis-directed therapy (MDT) improves progression-free survival. While a proportion of patients appear to have long-term disease control with MDT alone, further work in biomarker discovery is required to better identify which patients would be appropriate for de-escalated therapy.
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Affiliation(s)
- Matthew P Deek
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Philip Sutera
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yuezhou Jing
- The James Buchanan Brady Urological Institute of Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robert Gao
- Department of Radiation Oncology, The Mayo Clinic, Rochester, MN, USA
| | - Emily Rothman
- Department of Radiation Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Heather Day
- Department of Radiation Oncology, Australian Prostate Cancer Research Center, Queensland, Australia
| | - David Chang
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victoria, Australia
| | - Piet Dirix
- Department of Radiation-Oncology, GasthuisZusters Antwerp (GZA) 'Sisters of the Hospital', Antwerp, Belgium
| | - Andrew J Armstrong
- Department of Medicine, Division of Medical Oncology, Duke Cancer Institute Center for Prostate and Urologic Cancer, Duke University Medical Center, Durham, NC, USA
| | - Bethany Campbell
- Urology Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | | | - Miguel Berenguer
- Radiation Oncology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Matthew Ramotar
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Antonio Conde-Moreno
- Radiation Oncology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Alejandro Berlin
- Radiation Oncology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Davide Giovanni Bosetti
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Niall Corcoran
- Urology Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | | | - Carole Mercier
- Department of Radiation-Oncology, GasthuisZusters Antwerp (GZA) 'Sisters of the Hospital', Antwerp, Belgium
| | - Shankar Siva
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victoria, Australia
| | - David Pryor
- Department of Radiation Oncology, Australian Prostate Cancer Research Center, Queensland, Australia
| | - Piet Ost
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Mai Anh Huynh
- Department of Radiation Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Stephanie Kroeze
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Bradley Stish
- Department of Radiation Oncology, The Mayo Clinic, Rochester, MN, USA
| | - Ana Kiess
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bruce Trock
- The James Buchanan Brady Urological Institute of Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Phuoc T Tran
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Silke Gillessen
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Christopher Sweeney
- South Australian Immunogenomics Cancer Institute, University of Adelaide, Adelaide, Australia.
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Park JJ, Chu A, Li J, Ali A, McKay RR, Hwang C, Labriola MK, Jang A, Kilari D, Mo G, Ravindranathan D, Graham LS, Sokolova A, Tripathi A, Pilling A, Jindal T, Ravindra A, Cackowski FC, Sweeney PL, Thapa B, Amery TS, Heath EI, Garje R, Zakharia Y, Koshkin VS, Bilen MA, Schweizer MT, Barata PC, Dorff TB, Cieslik M, Alva AS, Armstrong AJ. Repeat Next-Generation Sequencing Testing on Progression in Men With Metastatic Prostate Cancer Can Identify New Actionable Alterations. JCO Precis Oncol 2024; 8:e2300567. [PMID: 38579192 DOI: 10.1200/po.23.00567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/03/2024] [Accepted: 02/07/2024] [Indexed: 04/07/2024] Open
Abstract
PURPOSE There are limited data available on the real-world patterns of molecular testing in men with advanced prostate cancer. We thus sought to evaluate next-generation sequencing (NGS) testing in the United States, focused on single versus serial NGS testing, the different disease states of testing (hormone-sensitive v castration-resistant, metastatic vs nonmetastatic), tissue versus plasma circulating tumor DNA (ctDNA) assays, and how often actionable data were found on each NGS test. METHODS The Prostate Cancer Precision Medicine Multi-Institutional Collaborative Effort clinical-genomic database was used for this retrospective analysis, including 1,597 patients across 15 institutions. Actionable NGS data were defined as including somatic alterations in homologous recombination repair genes, mismatch repair deficiency, microsatellite instability (MSI-high), or a high tumor mutational burden ≥10 mut/MB. RESULTS Serial NGS testing (two or more NGS tests with specimens collected more than 60 days apart) was performed in 9% (n = 144) of patients with a median of 182 days in between test results. For the second NGS test and beyond, 82.1% (225 of 274) of tests were from ctDNA assays and 76.1% (217 of 285) were collected in the metastatic castration-resistant setting. New actionable data were found on 11.1% (16 of 144) of second NGS tests, with 3.5% (5 of 144) of tests detecting a new BRCA2 alteration or MSI-high. A targeted therapy (poly (ADP-ribose) polymerase inhibitor or immunotherapy) was given after an actionable result on the second NGS test in 31.3% (5 of 16) of patients. CONCLUSION Repeat somatic NGS testing in men with prostate cancer is infrequently performed in practice and can identify new actionable alterations not present with initial testing, suggesting the utility of repeat molecular profiling with tissue or blood of men with metastatic castration-resistant prostate cancer to guide therapy choices.
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Affiliation(s)
- Joseph J Park
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, NC
| | - Alec Chu
- Division of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI
| | - Jinju Li
- Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | - Alicia Ali
- Division of Hematology and Oncology, Department of Medicine, University of Michigan, Ann Arbor, MI
| | - Rana R McKay
- Moores Cancer Center, University of California San Diego, La Jolla, CA
| | - Clara Hwang
- Division of Hematology/Oncology, Department of Internal Medicine, Henry Ford Health System, Detroit, MI
| | - Matthew K Labriola
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, NC
| | - Albert Jang
- Tulane Cancer Center, Tulane University, New Orleans, LA
| | - Deepak Kilari
- Department of Medicine, Froedtert Cancer Center, Medical College of Wisconsin, Milwaukee, WI
| | - George Mo
- University of Washington/Fred Hutchinson Cancer Center, Seattle, WA
| | | | - Laura S Graham
- University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Alexandra Sokolova
- Division of Medical Oncology, Oregon Health Science University, Portland, OR
| | - Abhishek Tripathi
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Amanda Pilling
- Division of Hematology/Oncology, Department of Internal Medicine, Henry Ford Health System, Detroit, MI
| | - Tanya Jindal
- Division of Hematology and Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA
| | | | | | | | - Bicky Thapa
- Department of Medicine, Froedtert Cancer Center, Medical College of Wisconsin, Milwaukee, WI
| | - Taylor S Amery
- Division of Medical Oncology, Oregon Health Science University, Portland, OR
| | | | | | | | - Vadim S Koshkin
- Division of Hematology and Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Mehmet A Bilen
- Winship Cancer Institute of Emory University, Atlanta, GA
| | | | - Pedro C Barata
- Tulane Cancer Center, Tulane University, New Orleans, LA
| | - Tanya B Dorff
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Marcin Cieslik
- Division of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI
| | - Ajjai S Alva
- Division of Hematology and Oncology, Department of Medicine, University of Michigan, Ann Arbor, MI
| | - Andrew J Armstrong
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, NC
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4
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Chi KN, Armstrong AJ, Krause BJ, Herrmann K, Rahbar K, de Bono JS, Adra N, Garje R, Michalski JM, Kempel MM, Fizazi K, Morris MJ, Sartor O, Brackman M, DeSilvio M, Wilke C, Holder G, Tagawa ST. Safety Analyses of the Phase 3 VISION Trial of [ 177Lu]Lu-PSMA-617 in Patients with Metastatic Castration-resistant Prostate Cancer. Eur Urol 2024; 85:382-391. [PMID: 38185538 DOI: 10.1016/j.eururo.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 11/30/2023] [Accepted: 12/11/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND AND OBJECTIVE [177Lu]Lu-PSMA-617 (177Lu-PSMA-617) plus the standard of care (SoC) significantly improved overall survival and radiographic progression-free survival versus SoC alone in patients with prostate-specific membrane antigen (PSMA)-positive metastatic castration-resistant prostate cancer in the VISION trial. We evaluated the safety of additional cycles of 177Lu-PSMA-617 and the impact of longer observation time for patients receiving 177Lu-PSMA-617 plus SoC. METHODS VISION was an international, open-label study. Patients were randomised 2:1 to receive 177Lu-PSMA-617 plus SoC or SoC alone. The incidence of treatment-emergent adverse events (TEAEs) was assessed in prespecified subgroups of patients who received ≤4 cycles versus 5-6 cycles of treatment and during each cycle of treatment. The TEAE incidence was also adjusted for treatment exposure to calculate the incidence per 100 patient-treatment years of observation. This analysis was performed for the first occurrence of TEAEs. KEY FINDINGS AND LIMITATIONS The any-grade TEAE incidence was similar in cycles 1-4 and cycles 5-6. TEAE frequency was similar across all cycles of 177Lu-PSMA-617 treatment. No additional safety concerns were reported for patients who received >4 cycles. The exposure-adjusted safety analysis revealed that the overall TEAE incidence was similar between arms, but distinct trends for different TEAE types were noted and the incidence of events associated with 177Lu-PSMA-617 remained higher in the 177Lu-PSMA-617 arm. CONCLUSIONS AND CLINICAL IMPLICATIONS Longer exposure to 177Lu-PSMA-617 plus SoC was not associated with a higher toxicity risk, and the extended time for safety observation could account for the higher TEAE incidence in comparison to SoC alone. The findings support a favourable benefit-risk profile for 6 cycles of 177Lu-PSMA-617 in this setting and the use of up to 6 cycles of 177Lu-PSMA-617 in patients who are clinically benefiting from and tolerating this therapy. PATIENT SUMMARY For patients with metastatic prostate cancer no longer responding to hormone therapy, an increase in the number of cycles of treatment with a radioactive compound called 177Lu-PSMA-617 from four to six had no additional adverse side effects.
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Affiliation(s)
- Kim N Chi
- British Columbia Cancer, Vancouver Prostate Centre, Vancouver, Canada.
| | - Andrew J Armstrong
- Duke Cancer Institute Center for Prostate & Urologic Cancers, Duke University, Durham, NC, USA
| | - Bernd J Krause
- Department of Nuclear Medicine, Rostock University Medical Center, Rostock, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
| | - Kambiz Rahbar
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
| | - Johann S de Bono
- Division of Clinical Studies, The Institute of Cancer Research and The Royal Marsden Hospital, London, UK
| | - Nabil Adra
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | - Rohan Garje
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Jeff M Michalski
- Department of Radiation Oncology, Washington University, St. Louis, MO, USA
| | - Mette M Kempel
- Department of Oncology and Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Karim Fizazi
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris-Saclay, Villejuif, France
| | - Michael J Morris
- Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Oliver Sartor
- Tulane Cancer Center, Tulane University School of Medicine, New Orleans, LA, USA
| | | | | | | | | | - Scott T Tagawa
- Hematology and Medical Oncology Department, Weill Cornell Medicine, New York, NY, USA
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Halabi S, Guo S, Park JJ, Nanus DM, George DJ, Antonarakis ES, Danila DC, Szmulewitz RZ, McDonnell DP, Norris JD, Lu C, Luo J, Armstrong AJ. The Impact of Circulating Tumor Cell HOXB13 RNA Detection in Men with Metastatic Castration-Resistant Prostate Cancer (mCRPC) Treated with Abiraterone or Enzalutamide. Clin Cancer Res 2024; 30:1152-1159. [PMID: 38236581 PMCID: PMC10947837 DOI: 10.1158/1078-0432.ccr-23-3017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/07/2023] [Accepted: 01/16/2024] [Indexed: 01/19/2024]
Abstract
PURPOSE HOXB13 is an androgen receptor (AR) coregulator specifically expressed in cells of prostatic lineage. We sought to associate circulating tumor cell (CTC) HOXB13 expression with outcomes in men with mCRPC treated with abiraterone or enzalutamide. EXPERIMENTAL DESIGN We conducted a retrospective analysis of the multicenter prospective PROPHECY trial of mCRPC men (NCT02269982, n = 118) treated with abiraterone/enzalutamide. CTC detection and HOXB13 complementary DNA (cDNA) expression was measured using a modified Adnatest, grouping patients into 3 categories: CTC 0 (undetectable); CTC+ HOXB13 CTC low (<4 copies); or CTC+ HOXB13 CTC high. The HOXB13 threshold was determined by maximally selected rank statistics for prognostic associations with overall survival (OS) and progression-free survival (PFS). RESULTS We included 102 men with sufficient CTC HOXB13 cDNA, identifying 25%, 31%, and 44% of patients who were CTC 0, CTC+ HOXB13 low, and CTC+ HOXB13 high, respectively. Median OS were 25.7, 27.8, and 12.1 months whereas the median PFS were 9.0, 7.7, and 3.8 months, respectively. In subgroup analysis among men with CellSearch CTCs ≥5 copies/mL and adjusting for prior abi/enza treatment and Halabi clinical risk score, the multivariate HR for HOXB13 CTC detection was 2.39 (95% CI, 1.06-5.40) for OS and 2.78 (95% CI, 1.38-5.59) for PFS, respectively. Low HOXB13 CTC detection was associated with lower CTC PSA, PSMA, AR-FL, and AR-V7 detection, and more liver/lung metastases (41% vs. 25%). CONCLUSIONS Higher CTC HOXB13 expression is associated with AR-dependent biomarkers in CTCs and is adversely prognostic in the context of potent AR inhibition in men with mCRPC.
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Affiliation(s)
- Susan Halabi
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
- Department of Medicine, Duke Prostate and Urologic Cancer Center, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Siyuan Guo
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Joseph J Park
- Department of Medicine, Duke Prostate and Urologic Cancer Center, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - David M Nanus
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Daniel J George
- Department of Medicine, Duke Prostate and Urologic Cancer Center, Duke Cancer Institute, Duke University, Durham, North Carolina
| | | | - Daniel Costin Danila
- Department of Medicine, Weill Cornell Medicine, New York, New York
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Donald P McDonnell
- Department of Medicine, Duke Prostate and Urologic Cancer Center, Duke Cancer Institute, Duke University, Durham, North Carolina
- Department of Pharmacology and Cancer Biology, Duke University, Durham, North Carolina
| | - John D Norris
- Department of Medicine, Duke Prostate and Urologic Cancer Center, Duke Cancer Institute, Duke University, Durham, North Carolina
- Department of Pharmacology and Cancer Biology, Duke University, Durham, North Carolina
| | - Changxue Lu
- Department of Urology, Johns Hopkins University, Baltimore, Maryland
| | - Jun Luo
- Department of Urology, Johns Hopkins University, Baltimore, Maryland
| | - Andrew J Armstrong
- Department of Medicine, Duke Prostate and Urologic Cancer Center, Duke Cancer Institute, Duke University, Durham, North Carolina
- Department of Pharmacology and Cancer Biology, Duke University, Durham, North Carolina
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6
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Fecteau RE, Koontz BF, Hoffman KE, Halabi S, Howard LE, Anand M, George DJ, Zhang T, Berry WR, Lee WR, Harrison MR, Corn PG, Armstrong AJ. Updated 5-year results for short course abiraterone acetate and LHRH agonist for unfavorable intermediate and favorable high-risk prostate cancer. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00811-5. [PMID: 38388778 DOI: 10.1038/s41391-024-00811-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 02/06/2024] [Accepted: 02/13/2024] [Indexed: 02/24/2024]
Abstract
Combined androgen deprivation therapy (ADT) and radiotherapy (RT) improves outcomes for intermediate and high-risk prostate cancer. Treatment intensification with abiraterone acetate/prednisone (AAP) provides additional benefit for high-risk disease. We previously reported 3-year outcomes of a single-arm prospective multicenter trial (AbiRT trial) of 33 patients with unfavorable intermediate risk (UIR) and favorable high risk (FHR) prostate cancer undergoing short course, combination therapy with ADT, AAP, and RT. Here we report the final analysis demonstrating a high rate of testosterone recovery (97%) and excellent biochemical progression-free survival (97%) at 5 years. These data support comparative prospective studies of shorter, more potent ADT courses in favorable high-risk prostate cancer.
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Affiliation(s)
- Ryan E Fecteau
- Department of Radiation Oncology, Duke University, Durham, NC, USA
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA
| | - Bridget F Koontz
- East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - Karen E Hoffman
- Department of Genitourinary Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Susan Halabi
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA
| | - Lauren E Howard
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA
| | - Monika Anand
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA
| | - Daniel J George
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA
- Department of Medicine, Division of Medical Oncology, Duke University, Durham, NC, USA
| | - Tian Zhang
- Department of Internal Medicine, Division of Hematology/Oncology, UT Southwestern Medical Center, Dallas, TX, USA
| | - William R Berry
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA
- Department of Medicine, Division of Medical Oncology, Duke University, Durham, NC, USA
| | - W Robert Lee
- Department of Radiation Oncology, Duke University, Durham, NC, USA
| | - Michael R Harrison
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA
- Department of Medicine, Division of Medical Oncology, Duke University, Durham, NC, USA
| | - Paul G Corn
- Department of Genitourinary Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Andrew J Armstrong
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA.
- Department of Medicine, Division of Medical Oncology, Duke University, Durham, NC, USA.
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Zengin ZB, Henderson NC, Park JJ, Ali A, Nguyen C, Hwang C, Barata PC, Bilen MA, Graham L, Mo G, Kilari D, Tripathi A, Labriola M, Rothstein S, Garje R, Koshkin VS, Patel VG, Schweizer MT, Armstrong AJ, McKay RR, Alva A, Dorff T. Clinical implications of AR alterations in advanced prostate cancer: a multi-institutional collaboration. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00805-3. [PMID: 38383885 DOI: 10.1038/s41391-024-00805-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 01/09/2024] [Accepted: 02/06/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND AR gene alterations can develop in response to pressure of testosterone suppression and androgen receptor targeting agents (ARTA). Despite this, the relevance of these gene alterations in the context of ARTA treatment and clinical outcomes remains unclear. METHODS Patients with castration-resistant prostate cancer (CRPC) who had undergone genomic testing and received ARTA treatment were identified in the Prostate Cancer Precision Medicine Multi-Institutional Collaborative Effort (PROMISE) database. Patients were stratified according to the timing of genomic testing relative to the first ARTA treatment (pre-/post-ARTA). Clinical outcomes such as time to progression, PSA response, and overall survival were compared based on alteration types. RESULTS In total, 540 CRPC patients who received ARTA and had tissue-based (n = 321) and/or blood-based (n = 244) genomic sequencing were identified. Median age was 62 years (range 39-90) at the time of the diagnosis. Majority were White (72.2%) and had metastatic disease (92.6%) at the time of the first ARTA treatment. Pre-ARTA genomic testing was available in 24.8% of the patients, and AR mutations and amplifications were observed in 8.2% and 13.1% of the patients, respectively. Further, time to progression was longer in patients with AR amplifications (25.7 months) compared to those without an AR alteration (9.6 months; p = 0.03). In the post-ARTA group (n = 406), AR mutations and AR amplifications were observed in 18.5% and 35.7% of the patients, respectively. The most common mutation in post-ARTA group was L702H (9.9%). CONCLUSION In this real-world clinicogenomics database-driven study we explored the development of AR alterations and their association with ARTA treatment outcomes. Our study showed that AR amplifications are associated with longer time to progression on first ARTA treatment. Further prospective studies are needed to optimize therapeutic strategies for patients with AR alterations.
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Affiliation(s)
- Zeynep B Zengin
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | | | - Joseph J Park
- Division of Hematology and Oncology, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Alicia Ali
- Division of Hematology and Oncology, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Charles Nguyen
- Division of Hematology and Oncology, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Clara Hwang
- Division of Hematology/Oncology, Department of Internal Medicine, Henry Ford Health System, Detroit, MI, USA
| | - Pedro C Barata
- Tulane Cancer Center, Tulane University, New Orleans, LA, USA
| | - Mehmet A Bilen
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Laura Graham
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - George Mo
- University of Washington/Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Deepak Kilari
- Department of Medicine, Froedtert Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Matthew Labriola
- Division of Medical Oncology, Duke University Medical Center, Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, NC, USA
| | | | - Rohan Garje
- Holden Comprehensive Cancer Center, Iowa City, IA, USA
| | - Vadim S Koshkin
- Division of Hematology and Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Vaibhav G Patel
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Arvinas Inc, New Haven, CT, USA
| | | | - Andrew J Armstrong
- Division of Medical Oncology, Duke University Medical Center, Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, NC, USA
| | - Rana R McKay
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Ajjai Alva
- Division of Hematology and Oncology, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Tanya Dorff
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
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8
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Nixon AB, Liu Y, Yang Q, Luo B, Starr MD, Brady JC, Kelly WK, Beltran H, Morris MJ, George DJ, Armstrong AJ, Halabi S. Prognostic and predictive analyses of circulating plasma biomarkers in men with metastatic castration resistant prostate cancer treated with docetaxel/prednisone with or without bevacizumab. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00794-3. [PMID: 38347114 DOI: 10.1038/s41391-024-00794-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 01/16/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND CALGB 90401 (Alliance) was a phase III trial of 1050 patients with metastatic castration-resistant prostate cancer (mCRPC) comparing docetaxel, prednisone, bevacizumab (DP+B) versus DP alone. While this trial did not show an improvement in overall survival (OS), there were improved intermediate outcomes suggesting that subsets of men may derive benefit from this combination. The purpose of this analysis was to identify prognostic and predictive biomarkers associated with OS and progression-free survival (PFS) benefit from DP+B. METHODS Baseline EDTA plasma samples from 650 consenting patients were analyzed for 24 biomarkers. The proportional hazards model was utilized to test for the prognostic and predictive importance of the biomarkers for OS. The statistically significant biomarkers of OS were further investigated for prognostic and predictive importance for other secondary outcomes. RESULTS 15 markers [ICAM-1, VEGF-R3, TIMP-1, TSP-2, Ang-2, Her-3, Osteopontin (OPN), PlGF, VCAM-1, HGF, VEGF, Chromogranin A, IL-6, VEGF-R1, BMP-9] were prognostic of OS, while 9 markers (ICAM-1, VEGF-R3, Her-3, TIMP-1, Ang-2, OPN, PlGF, HGF, and VEGF) were also prognostic of PFS. All markers were statistically significant in univariate analyses after adjustment for multiplicity (FDR < 0.1). In multivariable analyses of OS adjusting for risk score, seven markers had FDR < 0.1, including ICAM-1, VEGF-R3, TIMP-1, Ang-2, VEGF, TSP-2 and HGF. In unadjusted analysis, OPN was predictive of PFS improvement with DP+B, in both univariate and multivariable analysis. However, none of the biomarkers tested were predictive of clinical outcomes after adjusting for multiple comparisons. CONCLUSIONS Multiple biomarkers were identified in CALGB 90401 as prognostic of clinical outcomes but not predictive of OS. While OPN may have promise as a potential biomarker for anti-angiogenic therapies, further mechanistic and clinical studies are needed to determine the underlying biology and potential clinical application.
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Affiliation(s)
- Andrew B Nixon
- Department of Medicine, Duke University Medical Center, Durham, NC, USA.
| | - Yingmiao Liu
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Qian Yang
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Bin Luo
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Mark D Starr
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - John C Brady
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Wm Kevin Kelly
- Division of Solid Tumor Oncology, Department of Medical Oncology and Urology, Thomas Jefferson University and Sidney Kimmel Cancer Center, Philadelphia, PA, USA
| | - Himisha Beltran
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Michael J Morris
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniel J George
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University Medical Center, Durham, NC, USA
| | - Andrew J Armstrong
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University Medical Center, Durham, NC, USA
| | - Susan Halabi
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA.
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9
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Armstrong AJ, Geva R, Chung HC, Lemech C, Miller WH, Hansen AR, Lee JS, Tsai F, Solomon BJ, Kim TM, Rolfo C, Giranda V, Ren Y, Liu F, Kandala B, Freshwater T, Wang JS. CXCR2 antagonist navarixin in combination with pembrolizumab in select advanced solid tumors: a phase 2 randomized trial. Invest New Drugs 2024; 42:145-159. [PMID: 38324085 DOI: 10.1007/s10637-023-01410-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/08/2023] [Indexed: 02/08/2024]
Abstract
C-X-C motif chemokine receptor 2 (CXCR2) has a role in tumor progression, lineage plasticity, and reduction of immune checkpoint inhibitor efficacy. Preclinical evidence suggests potential benefit of CXCR2 inhibition in multiple solid tumors. In this phase 2 study (NCT03473925), adults with previously treated advanced or metastatic castration-resistant prostate cancer (CRPC), microsatellite-stable colorectal cancer (MSS CRC), or non-small-cell lung cancer (NSCLC) were randomized 1:1 to the CXCR2 antagonist navarixin 30 or 100 mg orally once daily plus pembrolizumab 200 mg intravenously every 3 weeks up to 35 cycles. Primary endpoints were investigator-assessed objective response rate (RECIST v1.1) and safety. Of 105 patients (CRPC, n=40; MSS CRC, n=40; NSCLC, n=25), 3 had a partial response (2 CRPC, 1 MSS CRC) for ORRs of 5%, 2.5%, and 0%, respectively. Median progression-free survival was 1.8-2.4 months without evidence of a dose-response relationship, and the study was closed at a prespecified interim analysis for lack of efficacy. Dose-limiting toxicities occurred in 2/48 patients (4%) receiving navarixin 30 mg and 3/48 (6%) receiving navarixin 100 mg; events included grade 4 neutropenia and grade 3 transaminase elevation, hepatitis, and pneumonitis. Treatment-related adverse events occurred in 70/105 patients (67%) and led to treatment discontinuation in 7/105 (7%). Maximal reductions from baseline in absolute neutrophil count were 44.5%-48.2% (cycle 1) and 37.5%-44.2% (cycle 2) and occurred within 6-12 hours postdose in both groups. Navarixin plus pembrolizumab did not demonstrate sufficient efficacy in this study. Safety and tolerability of the combination were manageable. (Trial registration: ClinicalTrials.gov , NCT03473925).
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Affiliation(s)
- Andrew J Armstrong
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, NC, 27710, USA.
| | - Ravit Geva
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hyun Cheol Chung
- Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea
| | | | - Wilson H Miller
- Segal Cancer Center, McGill University, Jewish General Hospital, Montreal, QC, Canada
| | | | - Jong-Seok Lee
- Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
| | | | | | - Tae Min Kim
- Seoul National University Hospital, Seoul, South Korea
| | - Christian Rolfo
- Center for Thoracic Oncology, Icahn School of Medicine at Mount Sinai, The Tisch Cancer Institute, New York, NY, USA
| | | | | | - Fang Liu
- Merck & Co., Inc, Rahway, NJ, USA
| | | | | | - Judy S Wang
- Florida Cancer Specialists/Sarah Cannon Research Institute, Sarasota, FL, USA
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10
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Paller CJ, Barata PC, Lorentz J, Appleman LJ, Armstrong AJ, DeMarco TA, Dreicer R, Elrod JAB, Fleming M, George C, Heath EI, Hussain MHA, Mao S, McKay RR, Morgans AK, Orton M, Pili R, Riedel E, Saraiya B, Sigmond J, Sokolova A, Stadler WM, Tran C, Macario N, Vinson J, Green R, Cheng HH. PROMISE Registry: A prostate cancer registry of outcomes and germline mutations for improved survival and treatment effectiveness. Prostate 2024; 84:292-302. [PMID: 37964482 DOI: 10.1002/pros.24650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Recently approved treatments and updates to genetic testing recommendations for prostate cancer have created a need for correlated analyses of patient outcomes data via germline genetic mutation status. Genetic registries address these gaps by identifying candidates for recently approved targeted treatments, expanding clinical trial data examining specific gene mutations, and understanding effects of targeted treatments in the real-world setting. METHODS The PROMISE Registry is a 20-year (5-year recruitment, 15-year follow-up), US-wide, prospective genetic registry for prostate cancer patients. Five thousand patients will be screened through an online at-home germline testing to identify and enroll 500 patients with germline mutations, including: pathogenic or likely pathogenic variants and variants of uncertain significance in genes of interest. Patients will be followed for 15 years and clinical data with real time patient reported outcomes will be collected. Eligible patients will enter long-term follow-up (6-month PRO surveys and medical record retrieval). As a virtual study with patient self-enrollment, the PROMISE Registry may fill gaps in genetics services in underserved areas and for patients within sufficient insurance coverage. RESULTS The PROMISE Registry opened in May 2021. 2114 patients have enrolled to date across 48 US states and 23 recruiting sites. 202 patients have met criteria for long-term follow-up. PROMISE is on target with the study's goal of 5000 patients screened and 500 patients eligible for long-term follow-up by 2026. CONCLUSIONS The PROMISE Registry is a novel, prospective, germline registry that will collect long-term patient outcomes data to address current gaps in understanding resulting from recently FDA-approved treatments and updates to genetic testing recommendations for prostate cancer. Through inclusion of a broad nationwide sample, including underserved patients and those unaffiliated with major academic centers, the PROMISE Registry aims to provide access to germline genetic testing and to collect data to understand disease characteristics and treatment responses across the disease spectrum for prostate cancer with rare germline genetic variants.
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Affiliation(s)
- Channing J Paller
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Pedro C Barata
- University Hospitals Seidman Cancer Center, Cleveland, Ohio, USA
| | - Justin Lorentz
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Leonard J Appleman
- University of Pittsburgh Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Andrew J Armstrong
- Duke Cancer Institute Center for Prostate & Urologic Cancers, Durham, North Carolina, USA
| | | | - Robert Dreicer
- University of Virginia Comprehensive Cancer Center, Charlottesville, Virginia, USA
| | - Jo Ann B Elrod
- Fred Hutchinson Cancer Center, Clinical Research Division, Seattle, Washington, USA
| | - Mark Fleming
- Virginia Oncology Associates, Norfolk, Virginia, USA
| | - Christopher George
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Elisabeth I Heath
- Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Maha H A Hussain
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Shifeng Mao
- Allegheny Health Network Cancer Institute, Pittsburgh, Pennsylvania, USA
| | - Rana R McKay
- Department of Oncology, University of California San Diego Moores Cancer Center, La Jolla, California, USA
| | - Alicia K Morgans
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Matthew Orton
- Indiana University Health Arnett Cancer Center, Lafayette, Indiana, USA
| | - Roberto Pili
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Elyn Riedel
- Prostate Cancer Clinical Trials Consortium, New York, New York, USA
| | - Biren Saraiya
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | | | - Alexandra Sokolova
- Oregon Health & Science University Knight Cancer Institute, Portland, Oregon, USA
| | - Walter M Stadler
- Department of Medicine, The University of Chicago Comprehensive Cancer Center, The University of Chicago Medicine, Chicago, Illinois, USA
| | - Christina Tran
- Prostate Cancer Clinical Trials Consortium, New York, New York, USA
| | - Natalie Macario
- Prostate Cancer Clinical Trials Consortium, New York, New York, USA
| | - Jacob Vinson
- Prostate Cancer Clinical Trials Consortium, New York, New York, USA
| | - Rebecca Green
- Prostate Cancer Clinical Trials Consortium, New York, New York, USA
| | - Heather H Cheng
- Fred Hutchinson Cancer Center, Clinical Research Division, Seattle, Washington, USA
- University of Washington, Department of Medicine, Seattle, Washington, USA
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11
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Kelly WK, Danila DC, Lin CC, Lee JL, Matsubara N, Ward PJ, Armstrong AJ, Pook D, Kim M, Dorff TB, Fischer S, Lin YC, Horvath LG, Sumey C, Yang Z, Jurida G, Smith KM, Connarn JN, Penny HL, Stieglmaier J, Appleman LJ. Xaluritamig, a STEAP1 × CD3 XmAb 2+1 Immune Therapy for Metastatic Castration-Resistant Prostate Cancer: Results from Dose Exploration in a First-in-Human Study. Cancer Discov 2024; 14:76-89. [PMID: 37861461 PMCID: PMC10784743 DOI: 10.1158/2159-8290.cd-23-0964] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/08/2023] [Accepted: 09/22/2023] [Indexed: 10/21/2023]
Abstract
Xaluritamig (AMG 509) is a six-transmembrane epithelial antigen of the prostate 1 (STEAP1)-targeted T-cell engager designed to facilitate lysis of STEAP1-expressing cancer cells, such as those in advanced prostate cancer. This first-in-human study reports monotherapy dose exploration for patients with metastatic castration-resistant prostate cancer (mCRPC), primarily taxane pretreated. Ninety-seven patients received ≥1 intravenous dose ranging from 0.001 to 2.0 mg weekly or every 2 weeks. MTD was identified as 1.5 mg i.v. weekly via a 3-step dose. The most common treatment-related adverse events were cytokine release syndrome (CRS; 72%), fatigue (45%), and myalgia (34%). CRS occurred primarily during cycle 1 and improved with premedication and step dosing. Prostate-specific antigen (PSA) and RECIST responses across cohorts were encouraging [49% PSA50; 24% objective response rate (ORR)], with greater frequency at target doses ≥0.75 mg (59% PSA50; 41% ORR). Xaluritamig is a novel immunotherapy for prostate cancer that has shown encouraging results supporting further development. SIGNIFICANCE Xaluritamig demonstrated encouraging responses (PSA and RECIST) compared with historical established treatments for patients with late-line mCRPC. This study provides proof of concept for T-cell engagers as a potential treatment for prostate cancer, validates STEAP1 as a target, and supports further clinical investigation of xaluritamig in prostate cancer. See related commentary by Hage Chehade et al., p. 20. See related article by Nolan-Stevaux et al., p. 90. This article is featured in Selected Articles from This Issue, p. 5.
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Affiliation(s)
- William K. Kelly
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania
- Sarah Cannon Research Institute, Nashville, Tennessee
| | - Daniel C. Danila
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Chia-Chi Lin
- National Taiwan University Hospital, Taipei, Taiwan
| | - Jae-Lyun Lee
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | | | - Patrick J. Ward
- Sarah Cannon Research Institute, Nashville, Tennessee
- Oncology Hematology Care, Cincinnati, Ohio
| | - Andrew J. Armstrong
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, North Carolina
| | - David Pook
- Monash Health, Clayton, Victoria, Australia
| | - Miso Kim
- Seoul National University Hospital, Seoul, South Korea
| | | | - Stefanie Fischer
- Department of Medical Oncology and Hematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Yung-Chang Lin
- Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Lisa G. Horvath
- Chris O'Brien Lifehouse, University of Sydney, Sydney, New South Wales, Australia
| | | | - Zhao Yang
- Amgen Inc., Thousand Oaks, California
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12
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McManus HD, Zhang D, Schwartz FR, Wu Y, Infield J, Ho E, Armstrong AJ, George DJ, Kruse D, Gupta RT, Harrison MR. Relationship Between Pretreatment Body Composition and Clinical Outcomes in Patients With Metastatic Renal Cell Carcinoma Receiving First-Line Ipilimumab Plus Nivolumab. Clin Genitourin Cancer 2023; 21:e429-e437.e2. [PMID: 37271698 DOI: 10.1016/j.clgc.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/03/2023] [Accepted: 05/07/2023] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Biomarkers are needed to identify patients with metastatic renal cell carcinoma (mRCC) most likely to benefit from immune checkpoint inhibitors. We examined associations between radiographically assessed body composition (BC) variables and body mass index (BMI) with clinical outcomes for patients with mRCC receiving first-line ipilimumab + nivolumab (ipi/nivo). PATIENTS AND METHODS We retrospectively reviewed all patients with mRCC treated with first-line ipi/nivo at one institution before June 1, 2021 with an analyzable baseline computed tomography (CT) scan. BC variables (skeletal muscle index [SMI], subcutaneous adipose tissue index [SATI], and visceral adipose tissue index [VATI]) were measured using baseline CT scans. Relationships between BC variables and clinical outcomes were examined using Cox proportional hazard regression models. RESULTS Ninety-nine patients were analyzed (74% male, 64% overweight/obese, 75% low SMI). Controlling for age, IMDC risk, and sex (for BMI analyses), high vs. low SMI (HR=2.433, CI: 1.397-4.238, P=.0017), high vs. low SATI (HR=1.641, CI: 1.023-2.632, P=.0398), and obese BMI (≥ 30 kg/m2) vs. normal/overweight BMI (<30 kg/m2) (HR=1.859, CI: 1.156-2.989, P=.0105) were significantly associated with progression-free survival (PFS). Median overall survival (OS) for low SMI patients was higher (42.74 months, CI: 26.84, NR) than median OS for high SMI patients (27.01 months, CI: 15.28, NR) (adjusted HR=1.728, CI: 0.909-3.285, P=.0952). No BC variables were significantly associated with OS or objective response rate. CONCLUSIONS Low SMI and low SATI were associated with significantly better PFS for patients with mRCC receiving first-line ipi/nivo. Radiographic BC variables may be useful prognostic biomarkers in this setting.
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Affiliation(s)
- Hannah D McManus
- Department of Medicine, Duke University Medical Center, Durham, NC.
| | - Dylan Zhang
- Department of Radiology, Duke University Medical Center, Durham, NC
| | - Fides R Schwartz
- Department of Radiology, Duke University Medical Center, Durham, NC
| | - Yuan Wu
- Department of Biostatics and Bioinformatics, Duke University, Durham, NC
| | - Jordan Infield
- Department of Medicine, Duke University Medical Center, Durham, NC
| | - Ethan Ho
- Department of Biomedical Engineering, Duke University, Durham, NC
| | - Andrew J Armstrong
- Department of Medicine, Duke University Medical Center, Durham, NC; Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC; Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, NC
| | - Daniel J George
- Department of Medicine, Duke University Medical Center, Durham, NC; Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC; Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, NC
| | - Danielle Kruse
- Department of Radiology, Duke University Medical Center, Durham, NC
| | - Rajan T Gupta
- Department of Radiology, Duke University Medical Center, Durham, NC; Department of Surgery, Division of Urology, Duke Cancer Institute, Durham, NC; Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC
| | - Michael R Harrison
- Department of Medicine, Duke University Medical Center, Durham, NC; Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC; Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, NC
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13
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Saad F, Clarke NW, Oya M, Shore N, Procopio G, Guedes JD, Arslan C, Mehra N, Parnis F, Brown E, Schlürmann F, Joung JY, Sugimoto M, Sartor O, Liu YZ, Poehlein C, Barker L, Del Rosario PM, Armstrong AJ. Olaparib plus abiraterone versus placebo plus abiraterone in metastatic castration-resistant prostate cancer (PROpel): final prespecified overall survival results of a randomised, double-blind, phase 3 trial. Lancet Oncol 2023; 24:1094-1108. [PMID: 37714168 DOI: 10.1016/s1470-2045(23)00382-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND PROpel met its primary endpoint showing statistically significant improvement in radiographic progression-free survival with olaparib plus abiraterone versus placebo plus abiraterone in patients with first-line metastatic castration-resistant prostate cancer (mCRPC) unselected by homologous recombination repair mutation (HRRm) status, with benefit observed in all prespecified subgroups. Here we report the final prespecified overall survival analysis. METHODS This was a randomised, double-blind, phase 3 trial done at 126 centres in 17 countries worldwide. Patients with mCRPC aged at least 18 years, Eastern Cooperative Oncology Group performance status 0-1, a life expectancy of at least 6 months, with no previous systemic treatment for mCRPC and unselected by HRRm status were randomly assigned (1:1) centrally by means of an interactive voice response system-interactive web response system to abiraterone acetate (orally, 1000 mg once daily) plus prednisone or prednisolone with either olaparib (orally, 300 mg twice daily) or placebo. The patients, the investigator, and study centre staff were masked to drug allocation. Stratification factors were site of metastases and previous docetaxel at metastatic hormone-sensitive cancer stage. Radiographic progression-free survival was the primary endpoint and overall survival was a key secondary endpoint with alpha-control (alpha-threshold at prespecified final analysis: 0·0377 [two-sided]), evaluated in the intention-to-treat population. Safety was evaluated in all patients who received at least one dose of a study drug. This study is registered with ClinicalTrials.gov, NCT03732820, and is completed and no longer recruiting. FINDINGS Between Oct 31, 2018 and March 11, 2020, 1103 patients were screened, of whom 399 were randomly assigned to olaparib plus abiraterone and 397 to placebo plus abiraterone. Median follow-up for overall survival in patients with censored data was 36·6 months (IQR 34·1-40·3) for olaparib plus abiraterone and 36·5 months (33·8-40·3) for placebo plus abiraterone. Median overall survival was 42·1 months (95% CI 38·4-not reached) with olaparib plus abiraterone and 34·7 months (31·0-39·3) with placebo plus abiraterone (hazard ratio 0·81, 95% CI 0·67-1·00; p=0·054). The most common grade 3-4 adverse event was anaemia reported in 64 (16%) of 398 patients in the olaparib plus abiraterone and 13 (3%) of 396 patients in the placebo plus abiraterone group. Serious adverse events were reported in 161 (40%) in the olaparib plus abiraterone group and 126 (32%) in the placebo plus abiraterone group. One death in the placebo plus abiraterone group, from interstitial lung disease, was considered treatment related. INTERPRETATION Overall survival was not significantly different between treatment groups at this final prespecified analysis. FUNDING Supported by AstraZeneca and Merck Sharp & Dohme.
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Affiliation(s)
- Fred Saad
- Centre Hospitalier de l'Université de Montréal, Montreal, Canada.
| | - Noel W Clarke
- The Christie and Salford Royal Hospital NHS Foundation Trusts and University of Manchester, Manchester, UK.
| | | | - Neal Shore
- Carolina Urologic Research Center, Myrtle Beach, SC, USA
| | - Giuseppe Procopio
- Programma Prostata Fondazione Istituto Nazionale Tumori Milano, Milan, Italy
| | - João Daniel Guedes
- Hospital de Base de São José do Rio Preto, São José do Rio Preto, Brazil
| | - Cagatay Arslan
- Izmir Economy University Medical Point Hospital, Karsiyaka, Izmir, Turkey
| | - Niven Mehra
- Radboud Universitair Medisch Centrum, Nijmegen, Netherlands
| | | | - Emma Brown
- University Hospital Southampton, Southampton, UK
| | | | | | | | | | - Yu-Zhen Liu
- Precision Medicine, Oncology R&D, AstraZeneca, Cambridge, UK
| | | | - Laura Barker
- Global Medicines Development, Oncology R&D, AstraZeneca, Cambridge, UK
| | | | - Andrew J Armstrong
- Duke Cancer Institute Center for Prostate and Urologic Cancer, Duke University, Durham, NC, USA
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Ardolino LC, Dear R, Armstrong AJ, Gillessen S, Joshua AM. Re: Timothée Olivier, Kerrington Powell, Vinay Prasad. Lutetium-177-PSMA-617 in Metastatic Castration-resistant Prostate Cancer: Limitations of the VISION Trial. Eur Urol. 2023;84:4-6. Eur Urol 2023; 84:e94-e95. [PMID: 37355357 DOI: 10.1016/j.eururo.2023.04.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 04/28/2023] [Indexed: 06/26/2023]
Affiliation(s)
- Luke C Ardolino
- Garvan Institute of Medical Research, Sydney, Australia; Kinghorn Cancer Centre, St. Vincent's Hospital, Sydney, Australia; St. Vincent's Clinical School, University of New South Wales, Darlinghurst, Australia
| | - Rachel Dear
- Garvan Institute of Medical Research, Sydney, Australia; Kinghorn Cancer Centre, St. Vincent's Hospital, Sydney, Australia; St. Vincent's Clinical School, University of New South Wales, Darlinghurst, Australia
| | - Andrew J Armstrong
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, NC, USA
| | - Silke Gillessen
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland; Università della Svizzera Italiana, Lugano, Switzerland; Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Anthony M Joshua
- Garvan Institute of Medical Research, Sydney, Australia; Kinghorn Cancer Centre, St. Vincent's Hospital, Sydney, Australia; St. Vincent's Clinical School, University of New South Wales, Darlinghurst, Australia.
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15
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Hwang C, Henderson NC, Chu SC, Holland B, Cackowski FC, Pilling A, Jang A, Rothstein S, Labriola M, Park JJ, Ghose A, Bilen MA, Mustafa S, Kilari D, Pierro MJ, Thapa B, Tripathi A, Garje R, Ravindra A, Koshkin VS, Hernandez E, Schweizer MT, Armstrong AJ, McKay RR, Dorff TB, Alva AS, Barata PC. Biomarker-Directed Therapy in Black and White Men With Metastatic Castration-Resistant Prostate Cancer. JAMA Netw Open 2023; 6:e2334208. [PMID: 37721753 PMCID: PMC10507489 DOI: 10.1001/jamanetworkopen.2023.34208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 08/09/2023] [Indexed: 09/19/2023] Open
Abstract
Importance Black men have higher incidence and mortality from prostate cancer. Whether precision oncology disparities affect Black men with metastatic castration-resistant prostate cancer (mCRPC) is unknown. Objective To compare precision medicine data and outcomes between Black and White men with mCRPC. Design, Setting, and Participants This retrospective cohort study used data collected by the Prostate Cancer Precision Medicine Multi-Institutional Collaborative Effort (PROMISE) consortium, a multi-institutional registry with linked clinicogenomic data, from April 2020 to December 2021. Participants included Black and White patients with mCRPC with molecular data. Data were analyzed from December 2021 to May 2023. Exposures Database-reported race and ethnicity. Main Outcomes and Measures The primary outcome was the frequency of actionable molecular data, defined as the presence of mismatch repair deficiency (MMRD) or high microsatellite instability (MSI-H), homologous recombination repair deficiency, or tumor mutational burden of 10 mutations per megabase or greater. Secondary outcomes included the frequency of other alterations, the type and timing of genomic testing performed, and use of targeted therapy. Efficacy outcomes were prostate-specific antigen response rate, site-reported radiographic response, and overall survival. Results A total of 962 eligible patients with mCRPC were identified, including 204 Black patients (21.2%; median [IQR] age at diagnosis, 61 [55-67] years; 131 patients [64.2%] with Gleason scores 8-10; 92 patients [45.1%] with de novo metastatic disease) and 758 White patients (78.8%; median [IQR] age, 63 [57-69] years; 445 patients [58.7%] with Gleason scores 8-10; 310 patients [40.9%] with de novo metastatic disease). Median (IQR) follow-up from mCRPC was 26.6 (14.2-44.7) months. Blood-based molecular testing was more common in Black men (111 men [48.7%]) than White men (317 men [36.4%]; P < .001). Rates of actionable alterations were similar between groups (65 Black men [32.8%]; 215 White men [29.1%]; P = .35), but MMRD or MSI-H was more common in Black men (18 men [9.1]) than White men (36 men [4.9%]; P = .04). PTEN alterations were less frequent in Black men than White men (31 men [15.7%] vs 194 men [26.3%]; P = .003), as were TMPRSS alterations (14 men [7.1%] vs 155 men [21.0%]; P < .001). No other differences were seen in the 15 most frequently altered genes, including TP53, AR, CDK12, RB1, and PIK3CA. Matched targeted therapy was given less frequently in Black men than White men (22 men [33.5%] vs 115 men [53.5%]; P = .008). There were no differences in response to targeted therapy or survival between the two cohorts. Conclusions and Relevance This cohort study of men with mCRPC found higher frequency of MMRD or MSI-H and lower frequency of PTEN and TMPRSS alterations in Black men compared with White men. Although Black men received targeted therapy less frequently than White men, no differences were observed in clinical outcomes.
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Affiliation(s)
| | | | | | - Brandon Holland
- Wayne State University School of Medicine, Detroit, Michigan
| | - Frank C. Cackowski
- Wayne State University School of Medicine, Detroit, Michigan
- Karmanos Cancer Institute, Detroit, Michigan
| | | | | | - Shoshana Rothstein
- Wayne State University School of Medicine, Detroit, Michigan
- Karmanos Cancer Institute, Detroit, Michigan
| | - Matthew Labriola
- Division of Medical Oncology, Department of Medicine, Duke Cancer Institute Center for Prostate and Urologic Cancer, Duke University, Durham, North Carolina
| | | | | | | | | | | | | | - Bicky Thapa
- Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | | | | | - Vadim S. Koshkin
- University of California San Francisco, San Francisco, California
| | - Erik Hernandez
- University of California San Francisco, San Francisco, California
| | | | - Andrew J. Armstrong
- Division of Medical Oncology, Department of Medicine, Duke Cancer Institute Center for Prostate and Urologic Cancer, Duke University, Durham, North Carolina
| | - Rana R. McKay
- University of California San Diego, La Jolla, California
| | | | | | - Pedro C. Barata
- Tulane University, New Orleans, Louisiana
- University Hospitals Seidman Cancer Center, Cleveland, Ohio
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16
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Helzer KT, Sharifi MN, Sperger JM, Shi Y, Annala M, Bootsma ML, Reese SR, Taylor A, Kaufmann KR, Krause HK, Schehr JL, Sethakorn N, Kosoff D, Kyriakopoulos C, Burkard ME, Rydzewski NR, Yu M, Harari PM, Bassetti M, Blitzer G, Floberg J, Sjöström M, Quigley DA, Dehm SM, Armstrong AJ, Beltran H, McKay RR, Feng FY, O'Regan R, Wisinski KB, Emamekhoo H, Wyatt AW, Lang JM, Zhao SG. Fragmentomic analysis of circulating tumor DNA-targeted cancer panels. Ann Oncol 2023; 34:813-825. [PMID: 37330052 PMCID: PMC10527168 DOI: 10.1016/j.annonc.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 05/30/2023] [Accepted: 06/06/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND The isolation of cell-free DNA (cfDNA) from the bloodstream can be used to detect and analyze somatic alterations in circulating tumor DNA (ctDNA), and multiple cfDNA-targeted sequencing panels are now commercially available for Food and Drug Administration (FDA)-approved biomarker indications to guide treatment. More recently, cfDNA fragmentation patterns have emerged as a tool to infer epigenomic and transcriptomic information. However, most of these analyses used whole-genome sequencing, which is insufficient to identify FDA-approved biomarker indications in a cost-effective manner. PATIENTS AND METHODS We used machine learning models of fragmentation patterns at the first coding exon in standard targeted cancer gene cfDNA sequencing panels to distinguish between cancer and non-cancer patients, as well as the specific tumor type and subtype. We assessed this approach in two independent cohorts: a published cohort from GRAIL (breast, lung, and prostate cancers, non-cancer, n = 198) and an institutional cohort from the University of Wisconsin (UW; breast, lung, prostate, bladder cancers, n = 320). Each cohort was split 70%/30% into training and validation sets. RESULTS In the UW cohort, training cross-validated accuracy was 82.1%, and accuracy in the independent validation cohort was 86.6% despite a median ctDNA fraction of only 0.06. In the GRAIL cohort, to assess how this approach performs in very low ctDNA fractions, training and independent validation were split based on ctDNA fraction. Training cross-validated accuracy was 80.6%, and accuracy in the independent validation cohort was 76.3%. In the validation cohort where the ctDNA fractions were all <0.05 and as low as 0.0003, the cancer versus non-cancer area under the curve was 0.99. CONCLUSIONS To our knowledge, this is the first study to demonstrate that sequencing from targeted cfDNA panels can be utilized to analyze fragmentation patterns to classify cancer types, dramatically expanding the potential capabilities of existing clinically used panels at minimal additional cost.
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Affiliation(s)
- K T Helzer
- Department of Human Oncology, University of Wisconsin, Madison
| | - M N Sharifi
- Carbone Cancer Center, University of Wisconsin, Madison; Department of Medicine, University of Wisconsin, Madison, USA
| | - J M Sperger
- Department of Medicine, University of Wisconsin, Madison, USA
| | - Y Shi
- Department of Human Oncology, University of Wisconsin, Madison
| | - M Annala
- Department of Urologic Sciences, Vancouver Prostate Centre, University of British Columbia, Vancouver, Canada; Prostate Cancer Research Center, Faculty of Medicine and Health Technology, Tampere University and Tays Cancer Center, Tampere, Finland
| | - M L Bootsma
- Department of Human Oncology, University of Wisconsin, Madison
| | - S R Reese
- Department of Human Oncology, University of Wisconsin, Madison; Department of Medicine, University of Wisconsin, Madison, USA
| | - A Taylor
- Department of Medicine, University of Wisconsin, Madison, USA
| | - K R Kaufmann
- Department of Medicine, University of Wisconsin, Madison, USA
| | - H K Krause
- Department of Medicine, University of Wisconsin, Madison, USA
| | - J L Schehr
- Carbone Cancer Center, University of Wisconsin, Madison
| | - N Sethakorn
- Carbone Cancer Center, University of Wisconsin, Madison; Department of Medicine, University of Wisconsin, Madison, USA
| | - D Kosoff
- Carbone Cancer Center, University of Wisconsin, Madison; Department of Medicine, University of Wisconsin, Madison, USA
| | - C Kyriakopoulos
- Carbone Cancer Center, University of Wisconsin, Madison; Department of Medicine, University of Wisconsin, Madison, USA
| | - M E Burkard
- Carbone Cancer Center, University of Wisconsin, Madison; Department of Medicine, University of Wisconsin, Madison, USA
| | - N R Rydzewski
- Department of Human Oncology, University of Wisconsin, Madison
| | - M Yu
- Carbone Cancer Center, University of Wisconsin, Madison; Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison
| | - P M Harari
- Department of Human Oncology, University of Wisconsin, Madison; Carbone Cancer Center, University of Wisconsin, Madison
| | - M Bassetti
- Department of Human Oncology, University of Wisconsin, Madison; Carbone Cancer Center, University of Wisconsin, Madison
| | - G Blitzer
- Department of Human Oncology, University of Wisconsin, Madison; Carbone Cancer Center, University of Wisconsin, Madison
| | - J Floberg
- Department of Human Oncology, University of Wisconsin, Madison; Carbone Cancer Center, University of Wisconsin, Madison
| | - M Sjöström
- Department of Radiation Oncology, University of California San Francisco, San Francisco; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco
| | - D A Quigley
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco; Departments of Epidemiology and Biostatistics; Urology, University of California San Francisco, San Francisco
| | - S M Dehm
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
| | - A J Armstrong
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Department of Medicine, Duke University, Durham
| | - H Beltran
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston
| | - R R McKay
- Moores Cancer Center, University of California San Diego, La Jolla
| | - F Y Feng
- Department of Radiation Oncology, University of California San Francisco, San Francisco; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco; Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis; Division of Hematology and Oncology, Department of Medicine, University of California San Francisco, San Francisco
| | - R O'Regan
- Carbone Cancer Center, University of Wisconsin, Madison; Department of Medicine, University of Wisconsin, Madison, USA; Department of Medicine, University of Rochester, Rochester, USA
| | - K B Wisinski
- Carbone Cancer Center, University of Wisconsin, Madison; Department of Medicine, University of Wisconsin, Madison, USA
| | - H Emamekhoo
- Carbone Cancer Center, University of Wisconsin, Madison; Department of Medicine, University of Wisconsin, Madison, USA
| | - A W Wyatt
- Department of Urologic Sciences, Vancouver Prostate Centre, University of British Columbia, Vancouver, Canada; Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, Canada
| | - J M Lang
- Carbone Cancer Center, University of Wisconsin, Madison; Department of Medicine, University of Wisconsin, Madison, USA
| | - S G Zhao
- Department of Human Oncology, University of Wisconsin, Madison; Carbone Cancer Center, University of Wisconsin, Madison; William S. Middleton Memorial Veterans' Hospital, Madison, USA.
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Spratt DE, Tang S, Sun Y, Huang HC, Chen E, Mohamad O, Armstrong AJ, Tward JD, Nguyen PL, Lang JM, Zhang J, Mitani A, Simko JP, DeVries S, van der Wal D, Pinckaers H, Monson JM, Campbell HA, Wallace J, Ferguson MJ, Bahary JP, Schaeffer EM, Sandler HM, Tran PT, Rodgers JP, Esteva A, Yamashita R, Feng FY. Artificial Intelligence Predictive Model for Hormone Therapy Use in Prostate Cancer. NEJM Evid 2023; 2:EVIDoa2300023. [PMID: 38320143 DOI: 10.1056/evidoa2300023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Predictive Model for Hormone Therapy in Prostate CancerDigital pathology images and clinical data from pretreatment prostate tissue were used to generate a predictive model to determine patients who would benefit from androgen deprivation therapy (ADT). In model-positive patients, ADT significantly reduced the risk of distant metastasis compared with radiotherapy alone.
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Affiliation(s)
- Daniel E Spratt
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland
| | - Siyi Tang
- Department of Electrical Engineering, Stanford University, Stanford, CA
- Artera, Inc., Los Altos, CA
| | - Yilun Sun
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland
| | | | | | - Osama Mohamad
- Department of Radiation Oncology, University of California, San Francisco, San Francisco
| | - Andrew J Armstrong
- Duke Cancer Institute Center for Prostate and Urologic Cancer, Division of Medical Oncology, Department of Medicine, Duke University, Durham, NC
| | - Jonathan D Tward
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber/Brigham Cancer Center, Boston
| | - Joshua M Lang
- Division of Hematology/Medical Oncology, University of Wisconsin, Madison, WI
| | | | | | - Jeffry P Simko
- Department of Radiation Oncology, University of California, San Francisco, San Francisco
| | - Sandy DeVries
- NRG Oncology Biospecimen Bank, University of California, San Francisco, San Francisco
| | | | | | - Jedidiah M Monson
- Department of Radiation Oncology, Saint Agnes Medical Center, Fresno, CA
| | - Holly A Campbell
- Department of Radiation Oncology, Saint John Regional Hospital, Saint John, NB, Canada
| | - James Wallace
- University of Chicago Medicine Medical Group, Chicago
| | - Michelle J Ferguson
- Department of Radiation Oncology, Allan Blair Cancer Centre, Regina, SK, Canada
| | - Jean-Paul Bahary
- Department of Radiation Oncology, Centre Hospitalier de l'Universite de Montreal, Montreal
| | - Edward M Schaeffer
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago
| | - Howard M Sandler
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles
| | - Phuoc T Tran
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore
| | - Joseph P Rodgers
- Statistics and Data Management Center, NRG Oncology, Philadelphia
- Statistics and Data Management Center, American College of Radiology, Philadelphia
| | | | | | - Felix Y Feng
- Department of Radiation Oncology, University of California, San Francisco, San Francisco
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18
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Bitting RL, Wu Y, Somarelli JA, Proudfoot JA, Liu Y, Davicioni E, George DJ, Armstrong AJ. Transcriptomic Signatures Associated With Outcomes in Recurrent Prostate Cancer Treated With Salvage Radiation, Androgen-Deprivation Therapy, and Enzalutamide: Correlative Analysis of the STREAM Trial. JCO Precis Oncol 2023; 7:e2300214. [PMID: 37595184 PMCID: PMC10581641 DOI: 10.1200/po.23.00214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/01/2023] [Accepted: 07/12/2023] [Indexed: 08/20/2023] Open
Abstract
PURPOSE Men with rising prostate-specific antigen (PSA) after radical prostatectomy (RP) may progress despite radiation and androgen-deprivation therapy (ADT). Tissue-based transcriptomic signatures can identify who may benefit from a more aggressive systemic approach. METHODS We performed a retrospective analysis of a prospective phase II multicenter trial of enzalutamide, ADT, and salvage radiotherapy in men with rising PSA after RP. Tumor tissue was analyzed using the Decipher platform for gene expression, including a novel prostate subtyping classifier, PTEN loss, homologous recombination deficiency (HRD), and ADT response. Cox models were used to associate signature scores with progression-free survival (PFS). RESULTS Of the 38 men enrolled, 31 had tissue with sufficient-quality RNA for genomic analysis. Luminal differentiated (LD) subtype tumors had the longest 3-year PFS at 89% compared with 19% in the luminal proliferating subtype. Men with signatures of PTEN loss (hazard ratio [HR], 1.32; 95% CI, 1.07 to 1.64; P = .01) or HRD (HR, 1.21; 95% CI, 1.05 to 1.39; P = .009) had worse PFS, while those with higher ADT response signature scores (HR, 0.75; 95% CI, 0.61 to 0.94; P = .01) were associated with improved PFS. Analysis of these signatures in a large cohort (n = 5,330) of RP samples from patients with biochemical recurrence found that these signatures provide complementary information related to outcomes with salvage radiation. CONCLUSION Despite aggressive systemic therapy with salvage radiation, nearly 50% of high-risk men relapse within 3 years. We show that LD and higher ADT sensitivity tumors had favorable outcomes. Those with a luminal proliferating subtype, PTEN loss, and/or HRD signatures had poor outcomes despite ADT/radiation and enzalutamide and may benefit from alternative approaches.
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Affiliation(s)
- Rhonda L. Bitting
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC
| | - Yuan Wu
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC
| | - Jason A. Somarelli
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC
| | | | - Yang Liu
- Veracyte, Inc, San Francisco, CA
| | | | - Daniel J. George
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC
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19
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Armstrong AJ, Iguchi T, Azad AA, Villers A, Alekseev B, Petrylak DP, Szmulewitz RZ, Alcaraz A, Shore ND, Holzbeierlein J, Gomez-Veiga F, Rosbrook B, Zohren F, Haas GP, Gourgiotti G, El-Chaar N, Stenzl A. The Efficacy of Enzalutamide plus Androgen Deprivation Therapy in Oligometastatic Hormone-sensitive Prostate Cancer: A Post Hoc Analysis of ARCHES. Eur Urol 2023; 84:229-241. [PMID: 37179240 DOI: 10.1016/j.eururo.2023.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 02/10/2023] [Accepted: 04/03/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Few phase 3 studies have evaluated optimal systemic treatment strategies for patients with oligometastatic hormone-sensitive prostate cancer (HSPC), who may be at risk of undertreatment. OBJECTIVE To evaluate outcomes for patients with oligometastatic and polymetastatic HSPC treated with enzalutamide plus androgen deprivation therapy (ADT) versus placebo plus ADT. DESIGN, SETTING, AND PARTICIPANTS This was a post hoc analysis of data for 927 patients with nonvisceral metastatic HSPC in the ARCHES trial (NCT02677896). INTERVENTION Patients were randomized 1:1 to enzalutamide (160 mg/d orally) plus ADT or placebo plus ADT with HSPC categorized as oligometastatic (1-5 metastases) or polymetastatic (≥6 metastases). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The treatment effect on radiographic progression-free survival (rPFS), overall survival (OS), and secondary efficacy endpoints was evaluated in terms of the number of metastases. Safety was assessed. Cox proportional hazards models were used to generate hazard ratios (HRs). The Brookmeyer and Crowley method was used to generate 95% confidence intervals (CIs) for Kaplan-Meier median values. RESULTS AND LIMITATIONS Enzalutamide plus ADT improved rPFS (HR 0.27, 95% CI 0.16-0.46; p < 0.001), OS (HR 0.59, 95% CI 0.40-0.87; p < 0.005), and secondary endpoints in patients with oligometastatic or polymetastatic disease (rPFS: HR 0.33, 95% CI 0.23-0.46; p < 0.001; OS: HR 0.55, 95% CI 0.41-0.74; p < 0.001). Safety profiles were generally similar across subgroups. Limitations include the small numbers of patients with fewer than three metastases. CONCLUSIONS This post hoc analysis demonstrated the utility of enzalutamide, irrespective of metastatic burden or type of oligometastatic disease, and suggests that earlier treatment intensification with systemic potent androgen receptor inhibition is advantageous. PATIENT SUMMARY This study considered two treatment options for metastatic hormone-sensitive prostate cancer in patients with one to five metastases or six or more metastases. Treatment with enzalutamide plus ADT improved survival and other outcomes over ADT alone, whether patients had few or many metastases.
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Affiliation(s)
- Andrew J Armstrong
- Center for Prostate & Urologic Cancers, Duke Cancer Institute, Durham, NC, USA.
| | - Taro Iguchi
- Kanazawa Medical University, Ishikawa, Japan
| | | | | | - Boris Alekseev
- Hertzen Moscow Cancer Research Institute, Moscow, Russia
| | - Daniel P Petrylak
- Department of Medical Oncology, Yale Cancer Center, New Haven, CT, USA
| | | | | | - Neal D Shore
- Carolina Urologic Research Center, Myrtle Beach, SC, USA
| | | | - Francisco Gomez-Veiga
- Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain
| | | | | | | | | | | | - Arnulf Stenzl
- Department of Urology, University Hospital, Eberhard Karls University of Tübingen, Tübingen, Germany
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20
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Morris MJ, Heller G, Hillman DW, Bobek O, Ryan C, Antonarakis ES, Bryce AH, Hahn O, Beltran H, Armstrong AJ, Schwartz L, Lewis LD, Beumer JH, Langevin B, McGary EC, Mehan PT, Goldkorn A, Roth BJ, Xiao H, Watt C, Taplin ME, Halabi S, Small EJ. Randomized Phase III Study of Enzalutamide Compared With Enzalutamide Plus Abiraterone for Metastatic Castration-Resistant Prostate Cancer (Alliance A031201 Trial). J Clin Oncol 2023; 41:3352-3362. [PMID: 36996380 PMCID: PMC10414728 DOI: 10.1200/jco.22.02394] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 01/01/2023] [Accepted: 02/09/2023] [Indexed: 04/01/2023] Open
Abstract
PURPOSE Enzalutamide and abiraterone both target androgen receptor signaling but via different mechanisms. The mechanism of action of one drug may counteract the resistance pathways of the other. We sought to determine whether the addition of abiraterone acetate and prednisone (AAP) to enzalutamide prolongs overall survival (OS) in patients with metastatic castration-resistant prostate cancer (mCRPC) in the first-line setting. PATIENTS AND METHODS Men with untreated mCRPC were randomly assigned (1:1) to receive first-line enzalutamide with or without AAP. The primary end point was OS. Toxicity, prostate-specific antigen declines, pharmacokinetics, and radiographic progression-free survival (rPFS) were also examined. Data were analyzed using an intent-to-treat approach. The Kaplan-Meier estimate and the stratified log-rank statistic were used to compare OS between treatments. RESULTS In total, 1,311 patients were randomly assigned: 657 to enzalutamide and 654 to enzalutamide plus AAP. OS was not statistically different between the two arms (median, 32.7 [95% CI, 30.5 to 35.4] months for enzalutamide v 34.2 [95% CI, 31.4 to 37.3] months for enzalutamide and AAP; hazard ratio [HR], 0.89; one-sided P = .03; boundary nominal significance level = .02). rPFS was longer in the combination arm (median rPFS, 21.3 [95% CI, 19.4 to 22.9] months for enzalutamide v 24.3 [95% CI, 22.3 to 26.7] months for enzalutamide and AAP; HR, 0.86; two-sided P = .02). However, pharmacokinetic clearance of abiraterone was 2.2- to 2.9-fold higher when administered with enzalutamide, compared with clearance values for abiraterone alone. CONCLUSION The addition of AAP to enzalutamide for first-line treatment of mCRPC was not associated with a statistically significant benefit in OS. Drug-drug interactions between the two agents resulting in increased abiraterone clearance may partly account for this result, although these interactions did not prevent the combination regimen from having more nonhematologic toxicity.
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Affiliation(s)
- Michael J. Morris
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Glenn Heller
- Alliance Statistics and Data Management Center, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David W. Hillman
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN
| | - Olivia Bobek
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN
| | - Charles Ryan
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Emmanuel S. Antonarakis
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Alan H. Bryce
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ
| | - Olwen Hahn
- University of Chicago Medical Center, Chicago, IL
| | - Himisha Beltran
- Department of Medical Oncology, Dana-Farber/Partners Cancer Care, Boston, MA
| | - Andrew J. Armstrong
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Division of Medical Oncology, Department of Medicine, Duke University, Durham, NC
| | - Lawrence Schwartz
- Department of Radiology, Columbia University Irving Medical Center, New York, NY
| | - Lionel D. Lewis
- Norris Cotton Cancer Center, The Geisel School of Medicine at Dartmouth and The Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | - Brooke Langevin
- Center for Translational Medicine, University of Maryland School of Pharmacy, Baltimore, MD
| | - Eric C. McGary
- Division of Medical Oncology, Kaiser Permanente (SCAL) and Kaiser Permanente School of Medicine, Cadillac, CA
| | | | - Amir Goldkorn
- Division of Medical Oncology, Department of Medicine, Keck School of Medicine and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Bruce J. Roth
- Washington University School of Medicine, St Louis, MO
| | - Han Xiao
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Mary-Ellen Taplin
- Department of Medical Oncology, Dana-Farber/Partners Cancer Care, Boston, MA
| | - Susan Halabi
- Alliance Statistics and Data Management Center, and Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - Eric J. Small
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
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21
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Armstrong AJ. Predictive biomarkers in advanced prostate cancer. Clin Adv Hematol Oncol 2023:290-293. [PMID: 37530633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
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22
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McManus HD, Armstrong AJ. Reply to E. Hindié. J Clin Oncol 2023:JCO2300794. [PMID: 37257141 DOI: 10.1200/jco.23.00794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 06/02/2023] Open
Affiliation(s)
- Hannah D McManus
- Hannah D. McManus, MD and Andrew J. Armstrong, MD, ScM, FACP, Department of Medicine, Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, NC
| | - Andrew J Armstrong
- Hannah D. McManus, MD and Andrew J. Armstrong, MD, ScM, FACP, Department of Medicine, Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, NC
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23
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Halabi S, Yang Q, Roy A, Luo B, Araujo JC, Logothetis C, Sternberg CN, Armstrong AJ, Carducci MA, Chi KN, de Bono JS, Petrylak DP, Fizazi K, Higano CS, Morris MJ, Rathkopf DE, Saad F, Ryan CJ, Small EJ, Kelly WK. External Validation of a Prognostic Model of Overall Survival in Men With Chemotherapy-Naïve Metastatic Castration-Resistant Prostate Cancer. J Clin Oncol 2023; 41:2736-2746. [PMID: 37040594 PMCID: PMC10414709 DOI: 10.1200/jco.22.02661] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/04/2023] [Accepted: 02/15/2023] [Indexed: 04/13/2023] Open
Abstract
PURPOSE We have previously developed and externally validated a prognostic model of overall survival (OS) in men with metastatic, castration-resistant prostate cancer (mCRPC) treated with docetaxel. We sought to externally validate this model in a broader group of men with docetaxel-naïve mCRPC and in specific subgroups (White, Black, Asian patients, different age groups, and specific treatments) and to classify patients into validated two and three prognostic risk groupings on the basis of the model. METHODS Data from 8,083 docetaxel-naïve mCRPC men randomly assigned on seven phase III trials were used to validate the prognostic model of OS. We assessed the predictive performance of the model by computing the time-dependent area under the receiver operating characteristic curve (tAUC) and validated the two-risk (low and high) and three-risk prognostic groups (low, intermediate, and high). RESULTS The tAUC was 0.74 (95% CI, 0.73 to 0.75), and when adjusting for the first-line androgen receptor (AR) inhibitor trial status, the tAUC was 0.75 (95% CI, 0.74 to 0.76). Similar results were observed by the different racial, age, and treatment subgroups. In patients enrolled on first-line AR inhibitor trials, the median OS (months) in the low-, intermediate-, and high-prognostic risk groups were 43.3 (95% CI, 40.7 to 45.8), 27.7 (95% CI, 25.8 to 31.3), and 15.4 (95% CI, 14.0 to 17.9), respectively. Compared with the low-risk prognostic group, the hazard ratios for the high- and intermediate-risk groups were 4.3 (95% CI, 3.6 to 5.1; P < .0001) and 1.9 (95% CI, 1.7 to 2.1; P < .0001). CONCLUSION This prognostic model for OS in docetaxel-naïve men with mCRPC has been validated using data from seven trials and yields similar results overall and across race, age, and different treatment classes. The prognostic risk groups are robust and can be used to identify groups of patients for enrichment designs and for stratification in randomized clinical trials.
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Affiliation(s)
- Susan Halabi
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
- Department of Medicine, Duke Cancer Institute Center for Prostate and Urologic Cancer, Duke University, Durham, NC
| | - Qian Yang
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - Akash Roy
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - Bin Luo
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - John C. Araujo
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Cora N. Sternberg
- Englander Institute for Precision Medicine, Meyer Cancer Center, Weill Cornell Medicine and New York-Presbyterian Hospital, New York, NY
| | - Andrew J. Armstrong
- Department of Medicine, Duke Cancer Institute Center for Prostate and Urologic Cancer, Duke University, Durham, NC
| | - Michael A. Carducci
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Kim N. Chi
- British Columbia Cancer Agency—Vancouver Centre, Vancouver, BC, Canada
| | - Johann S. de Bono
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | | | - Karim Fizazi
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Sud, Villejuif, France
| | | | | | | | - Fred Saad
- University of Montreal Hospital Center, Montreal, QC, Canada
| | - Charles J. Ryan
- Prostate Cancer Foundation and the University of Minnesota, Minneapolis, MN
| | - Eric J. Small
- University of California, San Francisco, San Francisco, CA
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24
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Ware KE, Thomas BC, Olawuni PD, Sheth MU, Hawkey N, Yeshwanth M, Miller BC, Vietor KJ, Jolly MK, Kim SY, Armstrong AJ, Somarelli JA. A synthetic lethal screen for Snail-induced enzalutamide resistance identifies JAK/STAT signaling as a therapeutic vulnerability in prostate cancer. Front Mol Biosci 2023; 10:1104505. [PMID: 37228586 PMCID: PMC10203420 DOI: 10.3389/fmolb.2023.1104505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/25/2023] [Indexed: 05/27/2023] Open
Abstract
Despite substantial improvements in the treatment landscape of prostate cancer, the evolution of hormone therapy-resistant and metastatic prostate cancer remains a major cause of cancer-related death globally. The mainstay of treatment for advanced prostate cancer is targeting of androgen receptor signaling, including androgen deprivation therapy plus second-generation androgen receptor blockade (e.g., enzalutamide, apalutamide, darolutamide), and/or androgen synthesis inhibition (abiraterone). While these agents have significantly prolonged the lives of patients with advanced prostate cancer, is nearly universal. This therapy resistance is mediated by diverse mechanisms, including both androgen receptor-dependent mechanisms, such as androgen receptor mutations, amplifications, alternative splicing, and amplification, as well as non-androgen receptor-mediated mechanisms, such as lineage plasticity toward neuroendocrine-like or epithelial-mesenchymal transition (EMT)-like lineages. Our prior work identified the EMT transcriptional regulator Snail as critical to hormonal therapy resistance and is commonly detected in human metastatic prostate cancer. In the current study, we sought to interrogate the actionable landscape of EMT-mediated hormone therapy resistant prostate cancer to identify synthetic lethality and collateral sensitivity approaches to treating this aggressive, therapy-resistant disease state. Using a combination of high-throughput drug screens and multi-parameter phenotyping by confluence imaging, ATP production, and phenotypic plasticity reporters of EMT, we identified candidate synthetic lethalities to Snail-mediated EMT in prostate cancer. These analyses identified multiple actionable targets, such as XPO1, PI3K/mTOR, aurora kinases, c-MET, polo-like kinases, and JAK/STAT as synthetic lethalities in Snail+ prostate cancer. We validated these targets in a subsequent validation screen in an LNCaP-derived model of resistance to sequential androgen deprivation and enzalutamide. This follow-up screen provided validation of inhibitors of JAK/STAT and PI3K/mTOR as therapeutic vulnerabilities for both Snail+ and enzalutamide-resistant prostate cancer.
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Affiliation(s)
- Kathryn E. Ware
- Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, NC, United States
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University Medical Center, Durham, NC, United States
| | - Beatrice C. Thomas
- Dr. Kiran C Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Pelumi D. Olawuni
- Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, NC, United States
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University Medical Center, Durham, NC, United States
| | - Maya U. Sheth
- Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, NC, United States
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University Medical Center, Durham, NC, United States
| | - Nathan Hawkey
- Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, NC, United States
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University Medical Center, Durham, NC, United States
| | - M. Yeshwanth
- Centre for BioSystems Science and Engineering, Indian Institute of Science, Bangalore, India
| | - Brian C. Miller
- Division of Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Katherine J. Vietor
- Division of Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Mohit Kumar Jolly
- Centre for BioSystems Science and Engineering, Indian Institute of Science, Bangalore, India
| | - So Young Kim
- Department of Molecular Genetics and Microbiology, Duke University Medical Center, Durham, NC, United States
| | - Andrew J. Armstrong
- Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, NC, United States
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University Medical Center, Durham, NC, United States
- Department of Pharmacology and Cancer Biology, Duke University, Durham, NC, United States
| | - Jason A. Somarelli
- Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, NC, United States
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University Medical Center, Durham, NC, United States
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25
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Butler W, Xu L, Zhou Y, Cheng Q, Hauck S, He Y, Marek R, Hartman Z, Cheng L, Yang Q, Wang ME, Chen M, Zhang H, Armstrong AJ, Huang J. Oncofetal protein glypican-3 is a biomarker and critical regulator of function for neuroendocrine cells in prostate cancer. J Pathol 2023; 260:43-55. [PMID: 36752189 PMCID: PMC10273879 DOI: 10.1002/path.6063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/27/2022] [Accepted: 02/04/2023] [Indexed: 02/09/2023]
Abstract
Neuroendocrine (NE) cells comprise ~1% of epithelial cells in benign prostate and prostatic adenocarcinoma (PCa). However, they become enriched in hormonally treated and castration-resistant PCa (CRPC). In addition, close to 20% of hormonally treated tumors recur as small cell NE carcinoma (SCNC), composed entirely of NE cells, which may be the result of clonal expansion or lineage plasticity. Since NE cells do not express androgen receptors (ARs), they are resistant to hormonal therapy and contribute to therapy failure. Here, we describe the identification of glypican-3 (GPC3) as an oncofetal cell surface protein specific to NE cells in prostate cancer. Functional studies revealed that GPC3 is critical to the viability of NE tumor cells and tumors displaying NE differentiation and that it regulates calcium homeostasis and signaling. Since our results demonstrate that GPC3 is specifically expressed by NE cells, patients with confirmed SCNC may qualify for GPC3-targeted therapy which has been developed in the context of liver cancer and displays minimal toxicity due to its tumor-specific expression. © 2023 The Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- William Butler
- Department of Pathology, Duke University School of Medicine, Durham NC, USA
| | - Lingfan Xu
- Department of Pathology, Duke University School of Medicine, Durham NC, USA
| | - Yinglu Zhou
- Department of Data Science, Dana-Farber Cancer Institute, Boston MA, USA
| | - Qing Cheng
- Department of Surgery, Duke University School of Medicine, Durham NC, USA
| | - Spencer Hauck
- Department of Pathology, Duke University School of Medicine, Durham NC, USA
| | - Yiping He
- Department of Pathology, Duke University School of Medicine, Durham NC, USA
| | - Robert Marek
- Department of Pathology, Duke University School of Medicine, Durham NC, USA
| | - Zachary Hartman
- Department of Surgery, Duke University School of Medicine, Durham NC, USA
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Warren Alpert Medical School of Brown University, Providence RI, USA
| | - Qing Yang
- School of Nursing, Duke University School of Medicine, Durham NC 27710, USA
| | - Mu-En Wang
- Department of Pathology, Duke University School of Medicine, Durham NC, USA
| | - Ming Chen
- Department of Pathology, Duke University School of Medicine, Durham NC, USA
| | - Hong Zhang
- Department of Pathology, Duke University School of Medicine, Durham NC, USA
| | - Andrew J. Armstrong
- Department of Medicine, Duke University School of Medicine, Durham NC 27710, USA
| | - Jiaoti Huang
- Department of Pathology, Duke University School of Medicine, Durham NC, USA
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26
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Gillessen S, Bossi A, Davis ID, de Bono J, Fizazi K, James ND, Mottet N, Shore N, Small E, Smith M, Sweeney CJ, Tombal B, Antonarakis ES, Aparicio AM, Armstrong AJ, Attard G, Beer TM, Beltran H, Bjartell A, Blanchard P, Briganti A, Bristow RG, Bulbul M, Caffo O, Castellano D, Castro E, Cheng HH, Chi KN, Chowdhury S, Clarke CS, Clarke N, Daugaard G, De Santis M, Duran I, Eeles R, Efstathiou E, Efstathiou J, Ekeke ON, Evans CP, Fanti S, Feng FY, Fonteyne V, Fossati N, Frydenberg M, George D, Gleave M, Gravis G, Halabi S, Heinrich D, Herrmann K, Higano C, Hofman MS, Horvath LG, Hussain M, Jereczek-Fossa BA, Jones R, Kanesvaran R, Kellokumpu-Lehtinen PL, Khauli RB, Klotz L, Kramer G, Leibowitz R, Logothetis C, Mahal B, Maluf F, Mateo J, Matheson D, Mehra N, Merseburger A, Morgans AK, Morris MJ, Mrabti H, Mukherji D, Murphy DG, Murthy V, Nguyen PL, Oh WK, Ost P, O'Sullivan JM, Padhani AR, Pezaro CJ, Poon DMC, Pritchard CC, Rabah DM, Rathkopf D, Reiter RE, Rubin MA, Ryan CJ, Saad F, Sade JP, Sartor O, Scher HI, Sharifi N, Skoneczna I, Soule H, Spratt DE, Srinivas S, Sternberg CN, Steuber T, Suzuki H, Sydes MR, Taplin ME, Tilki D, Türkeri L, Turco F, Uemura H, Uemura H, Ürün Y, Vale CL, van Oort I, Vapiwala N, Walz J, Yamoah K, Ye D, Yu EY, Zapatero A, Zilli T, Omlin A. Management of patients with advanced prostate cancer-metastatic and/or castration-resistant prostate cancer: Report of the Advanced Prostate Cancer Consensus Conference (APCCC) 2022. Eur J Cancer 2023; 185:178-215. [PMID: 37003085 DOI: 10.1016/j.ejca.2023.02.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Innovations in imaging and molecular characterisation together with novel treatment options have improved outcomes in advanced prostate cancer. However, we still lack high-level evidence in many areas relevant to making management decisions in daily clinical practise. The 2022 Advanced Prostate Cancer Consensus Conference (APCCC 2022) addressed some questions in these areas to supplement guidelines that mostly are based on level 1 evidence. OBJECTIVE To present the voting results of the APCCC 2022. DESIGN, SETTING, AND PARTICIPANTS The experts voted on controversial questions where high-level evidence is mostly lacking: locally advanced prostate cancer; biochemical recurrence after local treatment; metastatic hormone-sensitive, non-metastatic, and metastatic castration-resistant prostate cancer; oligometastatic prostate cancer; and managing side effects of hormonal therapy. A panel of 105 international prostate cancer experts voted on the consensus questions. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The panel voted on 198 pre-defined questions, which were developed by 117 voting and non-voting panel members prior to the conference following a modified Delphi process. A total of 116 questions on metastatic and/or castration-resistant prostate cancer are discussed in this manuscript. In 2022, the voting was done by a web-based survey because of COVID-19 restrictions. RESULTS AND LIMITATIONS The voting reflects the expert opinion of these panellists and did not incorporate a standard literature review or formal meta-analysis. The answer options for the consensus questions received varying degrees of support from panellists, as reflected in this article and the detailed voting results are reported in the supplementary material. We report here on topics in metastatic, hormone-sensitive prostate cancer (mHSPC), non-metastatic, castration-resistant prostate cancer (nmCRPC), metastatic castration-resistant prostate cancer (mCRPC), and oligometastatic and oligoprogressive prostate cancer. CONCLUSIONS These voting results in four specific areas from a panel of experts in advanced prostate cancer can help clinicians and patients navigate controversial areas of management for which high-level evidence is scant or conflicting and can help research funders and policy makers identify information gaps and consider what areas to explore further. However, diagnostic and treatment decisions always have to be individualised based on patient characteristics, including the extent and location of disease, prior treatment(s), co-morbidities, patient preferences, and treatment recommendations and should also incorporate current and emerging clinical evidence and logistic and economic factors. Enrolment in clinical trials is strongly encouraged. Importantly, APCCC 2022 once again identified important gaps where there is non-consensus and that merit evaluation in specifically designed trials. PATIENT SUMMARY The Advanced Prostate Cancer Consensus Conference (APCCC) provides a forum to discuss and debate current diagnostic and treatment options for patients with advanced prostate cancer. The conference aims to share the knowledge of international experts in prostate cancer with healthcare providers worldwide. At each APCCC, an expert panel votes on pre-defined questions that target the most clinically relevant areas of advanced prostate cancer treatment for which there are gaps in knowledge. The results of the voting provide a practical guide to help clinicians discuss therapeutic options with patients and their relatives as part of shared and multidisciplinary decision-making. This report focuses on the advanced setting, covering metastatic hormone-sensitive prostate cancer and both non-metastatic and metastatic castration-resistant prostate cancer. TWITTER SUMMARY Report of the results of APCCC 2022 for the following topics: mHSPC, nmCRPC, mCRPC, and oligometastatic prostate cancer. TAKE-HOME MESSAGE At APCCC 2022, clinically important questions in the management of advanced prostate cancer management were identified and discussed, and experts voted on pre-defined consensus questions. The report of the results for metastatic and/or castration-resistant prostate cancer is summarised here.
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Affiliation(s)
- Silke Gillessen
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland; Università della Svizzera Italiana, Lugano, Switzerland.
| | - Alberto Bossi
- Genitourinary Oncology, Prostate Brachytherapy Unit, Gustave Roussy, Paris, France
| | - Ian D Davis
- Monash University and Eastern Health, Victoria, Australia
| | - Johann de Bono
- The Institute of Cancer Research, London, UK; Royal Marsden Hospital, London, UK
| | - Karim Fizazi
- Institut Gustave Roussy, University of Paris Saclay, Villejuif, France
| | | | | | - Neal Shore
- Medical Director, Carolina Urologic Research Center, Myrtle Beach, SC, USA; CMO, Urology/Surgical Oncology, GenesisCare, Myrtle Beach, SC, USA
| | - Eric Small
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Matthew Smith
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Christopher J Sweeney
- South Australian Immunogenomics Cancer Institute, University of Adelaide, Adelaide, SA, Australia
| | | | | | - Ana M Aparicio
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Andrew J Armstrong
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA
| | | | - Tomasz M Beer
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Himisha Beltran
- Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anders Bjartell
- Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Pierre Blanchard
- Gustave Roussy, Département de Radiothérapie, Université Paris-Saclay, Oncostat, Inserm U-1018, F-94805, Villejuif, France
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Rob G Bristow
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Christie NHS Trust and CRUK Manchester Institute and Cancer Centre, Manchester, UK
| | - Muhammad Bulbul
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Orazio Caffo
- Department of Medical Oncology, Santa Chiara Hospital, 38122 Trento, Italy
| | - Daniel Castellano
- Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Elena Castro
- Institute of Biomedical Research in Málaga (IBIMA), Málaga, Spain
| | - Heather H Cheng
- University of Washington, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Kim N Chi
- BC Cancer, Vancouver Prostate Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Simon Chowdhury
- Guys and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - Caroline S Clarke
- Research Department of Primary Care & Population Health, Royal Free Campus, University College London, London, UK
| | - Noel Clarke
- The Christie and Salford Royal Hospitals, Manchester, UK
| | - Gedske Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Maria De Santis
- Department of Urology, Charité Universitätsmedizin, Berlin, Germany; Department of Urology, Medical University of Vienna, Austria
| | - Ignacio Duran
- Department of Medical Oncology, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Cantabria, Spain
| | - Ross Eeles
- The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | | | - Jason Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Onyeanunam Ngozi Ekeke
- Department of Surgery, University of Port Harcourt Teaching Hospital, Alakahia, Port Harcourt, Nigeria
| | | | - Stefano Fanti
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Felix Y Feng
- University of California, San Francisco, San Francisco, CA, USA
| | - Valerie Fonteyne
- Department of Radiation-Oncology, Ghent University Hospital, Ghent, Belgium
| | - Nicola Fossati
- Department of Urology, Ospedale Regionale di Lugano, Civico USI - Università della Svizzera Italiana, Lugano, Switzerland
| | - Mark Frydenberg
- Department of Surgery, Prostate Cancer Research Program, Department of Anatomy & Developmental Biology, Faculty Nursing, Medicine & Health Sciences, Monash University, Melbourne, Australia
| | - Dan George
- Departments of Medicine and Surgery, Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Martin Gleave
- Urological Sciences, Vancouver Prostate Centre, University of British Columbia, Vancouver, Canada
| | - Gwenaelle Gravis
- Department of Medical Oncology, Institut Paoli Calmettes, Aix-Marseille Université, Marseille, France
| | - Susan Halabi
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Daniel Heinrich
- Department of Oncology and Radiotherapy, Innlandet Hospital Trust, Gjøvik, Norway
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Celestia Higano
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael S Hofman
- Prostate Cancer Theranostics and Imaging Centre of Excellence, Department of Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Lisa G Horvath
- Chris O'Brien Lifehouse, Camperdown, NSW, Australia; Garvan Institute of Medical Research, Darlinghurst, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia
| | - Maha Hussain
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Barbara A Jereczek-Fossa
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; Department of Radiotherapy, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Rob Jones
- School of Cancer Sciences, University of Glasgow, United Kingdom
| | | | - Pirkko-Liisa Kellokumpu-Lehtinen
- Faculty of Medicine and Health Technology, Tampere University and Tampere Cancer Center, Tampere, Finland; Research, Development and Innovation Center, Tampere University Hospital, Tampere, Finland
| | - Raja B Khauli
- Division of Urology and the Naef K. Basile Cancer Institute (NKBCI), American University of Beirut Medical Center, Beirut, Lebanon
| | - Laurence Klotz
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Gero Kramer
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Raja Leibowitz
- Oncology Institute, Shamir Medical Center, Be'er Ya'akov, Israel; Faculty of Medicine, Tel-Aviv University, Israel
| | - Christopher Logothetis
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; University of Athens Alexandra Hospital, Athens, Greece
| | - Brandon Mahal
- Department of Radiation Oncology, University of Miami Sylvester Cancer Center, Miami, FL, USA
| | - Fernando Maluf
- Beneficiência Portuguesa de São Paulo, São Paulo, SP, Brasil; Departamento de Oncologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Joaquin Mateo
- Department of Medical Oncology and Prostate Cancer Translational Research Group. Vall d'Hebron Institute of Oncology (VHIO) and Vall d'Hebron University Hospital, Barcelona, Spain
| | - David Matheson
- Faculty of Education, Health and Wellbeing, Walsall Campus, Walsall, UK
| | - Niven Mehra
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Axel Merseburger
- Department of Urology, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Alicia K Morgans
- Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael J Morris
- Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hind Mrabti
- National Institute of Oncology, Mohamed V University, Rabat, Morocco
| | - Deborah Mukherji
- Clemenceau Medical Center Dubai, United Arab Emirates, Faculty of Medicine, American University of Beirut, Lebanon
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | | | - Paul L Nguyen
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - William K Oh
- Chief, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, The Tisch Cancer Institute, New York, NY, USA
| | - Piet Ost
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium; Department of Radiation Oncology, Iridium Netwerk, Antwerp, Belgium, Ghent University, Ghent, Belgium
| | - Joe M O'Sullivan
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, Northern Ireland
| | - Anwar R Padhani
- Mount Vernon Cancer Centre and Institute of Cancer Research, London, UK
| | - Carmel J Pezaro
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Darren M C Poon
- Comprehensive Oncology Centre, Hong Kong Sanatorium & Hospital, Hong Kong; The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Colin C Pritchard
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, USA
| | - Danny M Rabah
- Cancer Research Chair and Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Department of Urology, KFSHRC Riyadh, Saudi Arabia
| | - Dana Rathkopf
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Mark A Rubin
- Bern Center for Precision Medicine and Department for Biomedical Research, Bern, Switzerland
| | - Charles J Ryan
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Fred Saad
- Centre Hospitalier de Université de Montréal, Montreal, Canada
| | | | | | - Howard I Scher
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Nima Sharifi
- Department of Hematology and Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA; Department of Cancer Biology, GU Malignancies Research Center, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA
| | - Iwona Skoneczna
- Rafal Masztak Grochowski Hospital, Maria Sklodowska Curie National Research Institute of Oncology, Warsaw, Poland
| | - Howard Soule
- Prostate Cancer Foundation, Santa Monica, CA, USA
| | - Daniel E Spratt
- University Hospitals Seidman Cancer Center, Cleveland, OH, USA
| | - Sandy Srinivas
- Division of Medical Oncology, Stanford University Medical Center, Stanford, CA, USA
| | - Cora N Sternberg
- Englander Institute for Precision Medicine, Weill Cornell Medicine, Division of Hematology and Oncology, Meyer Cancer Center, New York Presbyterian Hospital, New York, NY, USA
| | - Thomas Steuber
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | - Matthew R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Mary-Ellen Taplin
- Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Koc University Hospital, Istanbul, Turkey
| | - Levent Türkeri
- Department of Urology, M.A. Aydınlar Acıbadem University, Altunizade Hospital, Istanbul, Turkey
| | - Fabio Turco
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - Hiroji Uemura
- Yokohama City University Medical Center, Yokohama, Japan
| | - Hirotsugu Uemura
- Department of Urology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yüksel Ürün
- Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey; Ankara University Cancer Research Institute, Ankara, Turkey
| | - Claire L Vale
- University College London, MRC Clinical Trials Unit at UCL, London, UK
| | - Inge van Oort
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Neha Vapiwala
- Department of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Jochen Walz
- Department of Urology, Institut Paoli-Calmettes Cancer Centre, Marseille, France
| | - Kosj Yamoah
- Department of Radiation Oncology & Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, University of South Florida, Tampa, FL, USA
| | - Dingwei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Evan Y Yu
- Department of Medicine, Division of Oncology, University of Washington and Fred Hutchinson Cancer Center, G4-830, Seattle, WA, USA
| | - Almudena Zapatero
- Department of Radiation Oncology, Hospital Universitario de La Princesa, Health Research Institute, Madrid, Spain
| | - Thomas Zilli
- Radiation Oncology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Aurelius Omlin
- Onkozentrum Zurich, University of Zurich and Tumorzentrum Hirslanden Zurich, Switzerland
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Spratt DE, Tang S, Sun Y, Huang HC, Chen E, Mohamad O, Armstrong AJ, Tward JD, Nguyen PL, Lang JM, Zhang J, Mitani A, Simko JP, DeVries S, van der Wal D, Pinckaers H, Monson JM, Campbell HA, Wallace J, Ferguson MJ, Bahary JP, Schaeffer EM, Sandler HM, Tran PT, Rodgers JP, Esteva A, Yamashita R, Feng FY. Artificial Intelligence Predictive Model for Hormone Therapy Use in Prostate Cancer. Res Sq 2023:rs.3.rs-2790858. [PMID: 37131691 PMCID: PMC10153374 DOI: 10.21203/rs.3.rs-2790858/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Background Androgen deprivation therapy (ADT) with radiotherapy can benefit patients with localized prostate cancer. However, ADT can negatively impact quality of life and there remain no validated predictive models to guide its use. Methods Digital pathology image and clinical data from pre-treatment prostate tissue from 5,727 patients enrolled on five phase III randomized trials treated with radiotherapy +/- ADT were used to develop and validate an artificial intelligence (AI)-derived predictive model to assess ADT benefit with the primary endpoint of distant metastasis. After the model was locked, validation was performed on NRG/RTOG 9408 (n = 1,594) that randomized men to radiotherapy +/- 4 months of ADT. Fine-Gray regression and restricted mean survival times were used to assess the interaction between treatment and predictive model and within predictive model positive and negative subgroup treatment effects. Results In the NRG/RTOG 9408 validation cohort (14.9 years of median follow-up), ADT significantly improved time to distant metastasis (subdistribution hazard ratio [sHR] = 0.64, 95%CI [0.45-0.90], p = 0.01). The predictive model-treatment interaction was significant (p-interaction = 0.01). In predictive model positive patients (n = 543, 34%), ADT significantly reduced the risk of distant metastasis compared to radiotherapy alone (sHR = 0.34, 95%CI [0.19-0.63], p < 0.001). There were no significant differences between treatment arms in the predictive model negative subgroup (n = 1,051, 66%; sHR = 0.92, 95%CI [0.59-1.43], p = 0.71). Conclusions Our data, derived and validated from completed randomized phase III trials, show that an AI-based predictive model was able to identify prostate cancer patients, with predominately intermediate-risk disease, who are likely to benefit from short-term ADT.
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28
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McManus HD, Armstrong AJ. The Past, Present, and Future of Treatment Intensification for Metastatic Hormone-Sensitive Prostate Cancer. J Clin Oncol 2023:JCO2300323. [PMID: 36947730 DOI: 10.1200/jco.23.00323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Affiliation(s)
- Hannah D McManus
- Department of Medicine, Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, NC
| | - Andrew J Armstrong
- Department of Medicine, Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, NC
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29
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Wang ME, Chen J, Lu Y, Bawcom AR, Wu J, Ou J, Asara JM, Armstrong AJ, Wang Q, Li L, Wang Y, Huang J, Chen M. RB1-deficient prostate tumor growth and metastasis are vulnerable to ferroptosis induction via the E2F/ACSL4 axis. J Clin Invest 2023; 133:166647. [PMID: 36928314 PMCID: PMC10178842 DOI: 10.1172/jci166647] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 03/14/2023] [Indexed: 03/18/2023] Open
Abstract
Inactivation of the RB1 tumor suppressor gene is common in several types of therapy-resistant cancers, including metastatic castration-resistant prostate cancer, and predicts poor clinical outcomes. Effective therapeutic strategies against RB1-deficient cancers, however, remain elusive. Here we showed that RB1-loss/E2F activation sensitized cancer cells to ferroptosis, a form of regulated cell death driven by iron-dependent lipid peroxidation, by upregulating expression of ACSL4 and enriching ACSL4-dependent arachidonic acid-containing phospholipids, which are key components of ferroptosis execution. ACSL4 appeared to be a direct E2F target gene and was critical to RB1 loss-induced sensitization to ferroptosis. Importantly, using cell line-derived xenografts and genetically engineered tumor models, we demonstrated that induction of ferroptosis in vivo by JKE-1674, a highly selective and stable GPX4 inhibitor, blocked RB1-deficient prostate tumor growth and metastasis and led to improved survival of the mice. Thus, our findings uncover an RB/E2F/ACSL4 molecular axis that governs ferroptosis, and also suggest a promising approach for the treatment of RB1-deficient malignancies.
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Affiliation(s)
- Mu-En Wang
- Department of Pathology, Duke University School of Medicine, Durham, United States of America
| | - Jiaqi Chen
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yi Lu
- Department of Pathology, Duke University School of Medicine, Durham, United States of America
| | - Alyssa R Bawcom
- Department of Pathology, Duke Univeristy School of Medicine, Durham, United States of America
| | - Jinjin Wu
- Department of Pathology, Duke University School of Medicine, Durham, United States of America
| | - Jianhong Ou
- Regeneration Center, Duke University, durham, United States of America
| | - John M Asara
- Division of Signal Transduction, Beth Isreal Deaconess Medical Center, Boston, United States of America
| | - Andrew J Armstrong
- Department of Medicine, Division of Medical Oncology and Urology, Duke University, Durham, United States of America
| | - Qianben Wang
- Department of Pathology, Duke University School of Medicine, Durham, United States of America
| | - Lei Li
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yuzhuo Wang
- Department of Urologic Sciences, The University of British Columbia, Vancouver, Canada
| | - Jiaoti Huang
- Department of Pathology, Duke University School of Medicine, Durham, United States of America
| | - Ming Chen
- Department of Pathology, Duke University School of Medicine, Durham, United States of America
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30
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Gupta S, Halabi S, Yang Q, Roy A, Tubbs A, Gore Y, George DJ, Nanus DM, Antonarakis ES, Danila DC, Szmulewitz RZ, Wenstrup R, Armstrong AJ. PSMA-positive circulating tumor cell detection and outcomes with abiraterone or enzalutamide treatment in men with metastatic castrate resistant prostate cancer. Clin Cancer Res 2023; 29:1929-1937. [PMID: 36897758 DOI: 10.1158/1078-0432.ccr-22-3233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/24/2023] [Accepted: 02/28/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND In men with mCRPC, PSMA-targeted radioligand therapy has drastically improved clinical outcomes. A liquid biopsy characterizing PSMA expression could be useful in guiding optimal therapy. METHODS We conducted a retrospective analysis of the prospective multicenter PROPHECY trial of men with mCRPC (n=118) treated with abiraterone (abi) or enzalutamide (enza). CTCs were enriched (CTC/mL) and characterized for PSMA protein expression/heterogeneity at baseline and progression. We utilized proportional hazards modeling of the association between PSMA+ CTC enumeration with overall survival(OS) and progression free survival(PFS). RESULTS Overall, 97 men with mCRPC had evaluable blood samples for baseline CTC PSMA detection; 78 men (80%) had detectable CTCs. Of these, 55%(43/78) men had any PSMA CTC detection, 21%(16/78) had ≥2 PSMA+ CTCs/mL, and 19%(8/43) were 100% PSMA positive. At progression on abi/enza, 88%(50/57) of men had detectable CTCs, 68%(34/50) had any PSMA CTCs, and 12%(4/34) had 100% PSMA+ CTCs. Among paired cases (n=57), PSMA+ CTC detection increased slightly after abi/enza progression. Using an optimal cut-off of ≥2 PSMA+ CTCs/mL, median OS was 26, 21, and 11 mo for men without CTCs, PSMA- CTCs, and PSMA+ CTCs. Adjusting for prior abi/enza therapy, Halabi clinical risk-score, and CTC enumeration, the hazard ratios for OS and PFS for PSMA+ CTC+ were 3.0 (95% CI=1.1-7.8) and 2.3 (95%CI=0.9-5.8). CONCLUSIONS We observed PSMA CTC heterogeneity between and within patients with mCRPC over time during abi/enza progression. CTC PSMA enumeration was adversely prognostic independent of clinical factors and disease burden. Further validation is warranted in the context of PSMA-targeted therapies.
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Affiliation(s)
| | | | - Qian Yang
- Duke Univ Medical Center, Durham, NC, United States
| | - Akash Roy
- Duke Medical Center, Durham, NC, United States
| | | | | | - Daniel J George
- Duke University, Duke Cancer Institute, Durham, NC, United States
| | | | | | - Daniel C Danila
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
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31
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Gillessen S, Bossi A, Davis ID, de Bono J, Fizazi K, James ND, Mottet N, Shore N, Small E, Smith M, Sweeney C, Tombal B, Antonarakis ES, Aparicio AM, Armstrong AJ, Attard G, Beer TM, Beltran H, Bjartell A, Blanchard P, Briganti A, Bristow RG, Bulbul M, Caffo O, Castellano D, Castro E, Cheng HH, Chi KN, Chowdhury S, Clarke CS, Clarke N, Daugaard G, De Santis M, Duran I, Eeles R, Efstathiou E, Efstathiou J, Ngozi Ekeke O, Evans CP, Fanti S, Feng FY, Fonteyne V, Fossati N, Frydenberg M, George D, Gleave M, Gravis G, Halabi S, Heinrich D, Herrmann K, Higano C, Hofman MS, Horvath LG, Hussain M, Jereczek-Fossa BA, Jones R, Kanesvaran R, Kellokumpu-Lehtinen PL, Khauli RB, Klotz L, Kramer G, Leibowitz R, Logothetis CJ, Mahal BA, Maluf F, Mateo J, Matheson D, Mehra N, Merseburger A, Morgans AK, Morris MJ, Mrabti H, Mukherji D, Murphy DG, Murthy V, Nguyen PL, Oh WK, Ost P, O'Sullivan JM, Padhani AR, Pezaro C, Poon DMC, Pritchard CC, Rabah DM, Rathkopf D, Reiter RE, Rubin MA, Ryan CJ, Saad F, Pablo Sade J, Sartor OA, Scher HI, Sharifi N, Skoneczna I, Soule H, Spratt DE, Srinivas S, Sternberg CN, Steuber T, Suzuki H, Sydes MR, Taplin ME, Tilki D, Türkeri L, Turco F, Uemura H, Uemura H, Ürün Y, Vale CL, van Oort I, Vapiwala N, Walz J, Yamoah K, Ye D, Yu EY, Zapatero A, Zilli T, Omlin A. Management of Patients with Advanced Prostate Cancer. Part I: Intermediate-/High-risk and Locally Advanced Disease, Biochemical Relapse, and Side Effects of Hormonal Treatment: Report of the Advanced Prostate Cancer Consensus Conference 2022. Eur Urol 2023; 83:267-293. [PMID: 36494221 PMCID: PMC7614721 DOI: 10.1016/j.eururo.2022.11.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/08/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Innovations in imaging and molecular characterisation and the evolution of new therapies have improved outcomes in advanced prostate cancer. Nonetheless, we continue to lack high-level evidence on a variety of clinical topics that greatly impact daily practice. To supplement evidence-based guidelines, the 2022 Advanced Prostate Cancer Consensus Conference (APCCC 2022) surveyed experts about key dilemmas in clinical management. OBJECTIVE To present consensus voting results for select questions from APCCC 2022. DESIGN, SETTING, AND PARTICIPANTS Before the conference, a panel of 117 international prostate cancer experts used a modified Delphi process to develop 198 multiple-choice consensus questions on (1) intermediate- and high-risk and locally advanced prostate cancer, (2) biochemical recurrence after local treatment, (3) side effects from hormonal therapies, (4) metastatic hormone-sensitive prostate cancer, (5) nonmetastatic castration-resistant prostate cancer, (6) metastatic castration-resistant prostate cancer, and (7) oligometastatic and oligoprogressive prostate cancer. Before the conference, these questions were administered via a web-based survey to the 105 physician panel members ("panellists") who directly engage in prostate cancer treatment decision-making. Herein, we present results for the 82 questions on topics 1-3. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Consensus was defined as ≥75% agreement, with strong consensus defined as ≥90% agreement. RESULTS AND LIMITATIONS The voting results reveal varying degrees of consensus, as is discussed in this article and shown in the detailed results in the Supplementary material. The findings reflect the opinions of an international panel of experts and did not incorporate a formal literature review and meta-analysis. CONCLUSIONS These voting results by a panel of international experts in advanced prostate cancer can help physicians and patients navigate controversial areas of clinical management for which high-level evidence is scant or conflicting. The findings can also help funders and policymakers prioritise areas for future research. Diagnostic and treatment decisions should always be individualised based on patient and cancer characteristics (disease extent and location, treatment history, comorbidities, and patient preferences) and should incorporate current and emerging clinical evidence, therapeutic guidelines, and logistic and economic factors. Enrolment in clinical trials is always strongly encouraged. Importantly, APCCC 2022 once again identified important gaps (areas of nonconsensus) that merit evaluation in specifically designed trials. PATIENT SUMMARY The Advanced Prostate Cancer Consensus Conference (APCCC) provides a forum to discuss and debate current diagnostic and treatment options for patients with advanced prostate cancer. The conference aims to share the knowledge of international experts in prostate cancer with health care providers and patients worldwide. At each APCCC, a panel of physician experts vote in response to multiple-choice questions about their clinical opinions and approaches to managing advanced prostate cancer. This report presents voting results for the subset of questions pertaining to intermediate- and high-risk and locally advanced prostate cancer, biochemical relapse after definitive treatment, advanced (next-generation) imaging, and management of side effects caused by hormonal therapies. The results provide a practical guide to help clinicians and patients discuss treatment options as part of shared multidisciplinary decision-making. The findings may be especially useful when there is little or no high-level evidence to guide treatment decisions.
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Affiliation(s)
- Silke Gillessen
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland; Università della Svizzera Italiana, Lugano, Switzerland.
| | - Alberto Bossi
- Genitourinary Oncology, Prostate Brachytherapy Unit, Gustave Roussy, Paris, France
| | - Ian D Davis
- Monash University and Eastern Health, Victoria, Australia
| | - Johann de Bono
- The Institute of Cancer Research, London, UK; Royal Marsden Hospital, London, UK
| | - Karim Fizazi
- Institut Gustave Roussy, University of Paris Saclay, Villejuif, France
| | | | | | - Neal Shore
- Carolina Urologic Research Center, Myrtle Beach, SC, USA; Urology/Surgical Oncology, GenesisCare, Myrtle Beach, SC, USA
| | - Eric Small
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Mathew Smith
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Christopher Sweeney
- Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Ana M Aparicio
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Andrew J Armstrong
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA
| | | | - Tomasz M Beer
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Himisha Beltran
- Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anders Bjartell
- Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Pierre Blanchard
- Département de Radiothérapie, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Rob G Bristow
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Christie NHS Trust and CRUK Manchester Institute and Cancer Centre, Manchester, UK
| | - Muhammad Bulbul
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Orazio Caffo
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Italy
| | - Daniel Castellano
- Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Elena Castro
- Institute of Biomedical Research in Málaga (IBIMA), Málaga, Spain
| | - Heather H Cheng
- Fred Hutchinson Cancer Center, University of Washington, Seattle, WA, USA
| | - Kim N Chi
- BC Cancer, Vancouver Prostate Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Caroline S Clarke
- Research Department of Primary Care & Population Health, Royal Free Campus, University College London, London, UK
| | - Noel Clarke
- The Christie and Salford Royal Hospitals, Manchester, UK
| | - Gedske Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Maria De Santis
- Department of Urology, Charité Universitätsmedizin, Berlin, Germany; Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Ignacio Duran
- Department of Medical Oncology, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Cantabria, Spain
| | - Ros Eeles
- The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | | | - Jason Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Onyeanunam Ngozi Ekeke
- Department of Surgery, University of Port Harcourt Teaching Hospital, Alakahia, Port Harcourt, Nigeria
| | | | - Stefano Fanti
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Felix Y Feng
- University of California San Francisco, San Francisco, CA, USA
| | - Valerie Fonteyne
- Department of Radiation-Oncology, Ghent University Hospital, Ghent, Belgium
| | - Nicola Fossati
- Department of Urology, Ospedale Regionale di Lugano, Civico USI - Università della Svizzera Italiana, Lugano, Switzerland
| | - Mark Frydenberg
- Department of Surgery, Prostate Cancer Research Program, Monash University, Melbourne, Australia; Department of Anatomy & Developmental Biology, Faculty of Nursing, Medicine & Health Sciences, Monash University, Melbourne, Australia
| | - Daniel George
- Department of Medicine, Duke Cancer Institute, Duke University, Durham, NC, USA; Department of Surgery, Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Martin Gleave
- Urological Sciences, Vancouver Prostate Centre, University of British Columbia, Vancouver, Canada
| | - Gwenaelle Gravis
- Department of Medical Oncology, Institut Paoli Calmettes, Aix-Marseille Université, Marseille, France
| | - Susan Halabi
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Daniel Heinrich
- Department of Oncology and Radiotherapy, Innlandet Hospital Trust, Gjøvik, Norway
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Celestia Higano
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael S Hofman
- Prostate Cancer Theranostics and Imaging Centre of Excellence, Department of Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Lisa G Horvath
- Chris O'Brien Lifehouse, Camperdown, NSW, Australia; Garvan Institute of Medical Research, Darlinghurst, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia
| | - Maha Hussain
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Barbara Alicja Jereczek-Fossa
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; Department of Radiotherapy, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Robert Jones
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | | | - Pirkko-Liisa Kellokumpu-Lehtinen
- Faculty of Medicine and Health Technology, Tampere University and Tampere Cancer Center, Tampere, Finland; Research, Development and Innovation Center, Tampere University Hospital, Tampere, Finland
| | - Raja B Khauli
- Department of Urology and the Naef K. Basile Cancer Institute (NKBCI), American University of Beirut Medical Center, Beirut, Lebanon
| | - Laurence Klotz
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Gero Kramer
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Raya Leibowitz
- Oncology Institute, Shamir Medical Center, Be'er Ya'akov, Israel; Faculty of Medicine, Tel-Aviv University, Israel
| | - Christopher J Logothetis
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; University of Athens Alexandra Hospital, Athens, Greece
| | - Brandon A Mahal
- Department of Radiation Oncology, University of Miami Sylvester Cancer Center, Miami, FL, USA
| | - Fernando Maluf
- Beneficiência Portuguesa de São Paulo, São Paulo, SP, Brasil; Departamento de Oncologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Joaquin Mateo
- Department of Medical Oncology and Prostate Cancer Translational Research Group, Vall d'Hebron Institute of Oncology (VHIO) and Vall d'Hebron University Hospital, Barcelona, Spain
| | - David Matheson
- Faculty of Education, Health and Wellbeing, Walsall Campus, Walsall, UK
| | - Niven Mehra
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Axel Merseburger
- Department of Urology, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Alicia K Morgans
- Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael J Morris
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hind Mrabti
- National Institute of Oncology, Mohamed V University, Rabat, Morocco
| | - Deborah Mukherji
- Clemenceau Medical Center, Dubai, United Arab Emirates; Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | | | - Paul L Nguyen
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - William K Oh
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, The Tisch Cancer Institute, New York, NY, USA
| | - Piet Ost
- Department of Radiation Oncology, Iridium Netwerk, Antwerp, Belgium; Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Joe M O'Sullivan
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, Northern Ireland
| | - Anwar R Padhani
- Mount Vernon Cancer Centre and Institute of Cancer Research, London, UK
| | - Carmel Pezaro
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Darren M C Poon
- Comprehensive Oncology Centre, Hong Kong Sanatorium & Hospital, Hong Kong; The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Colin C Pritchard
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Danny M Rabah
- Cancer Research Chair and Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Department of Urology, KFSHRC, Riyadh, Saudi Arabia
| | - Dana Rathkopf
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Mark A Rubin
- Bern Center for Precision Medicine and Department for Biomedical Research, Bern, Switzerland
| | - Charles J Ryan
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Fred Saad
- Centre Hospitalier de Université de Montréal, Montreal, Quebec, Canada
| | | | | | - Howard I Scher
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Nima Sharifi
- Department of Hematology and Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA; Department of Cancer Biology, GU Malignancies Research Center, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA
| | - Iwona Skoneczna
- Rafal Masztak Grochowski Hospital, Maria Sklodowska Curie National Research Institute of Oncology, Warsaw, Poland
| | - Howard Soule
- Prostate Cancer Foundation, Santa Monica, CA, USA
| | - Daniel E Spratt
- University Hospitals Seidman Cancer Center, Cleveland, OH, USA
| | - Sandy Srinivas
- Division of Medical Oncology, Stanford University Medical Center, Stanford, CA, USA
| | - Cora N Sternberg
- Englander Institute for Precision Medicine, Weill Cornell Medicine, Division of Hematology and Oncology, Meyer Cancer Center, New York Presbyterian Hospital, New York, NY, USA
| | - Thomas Steuber
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | - Matthew R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Mary-Ellen Taplin
- Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Koc University Hospital, Istanbul, Turkey
| | - Levent Türkeri
- Department of Urology, M.A. Aydınlar Acıbadem University, Altunizade Hospital, Istanbul, Turkey
| | - Fabio Turco
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - Hiroji Uemura
- Yokohama City University Medical Center, Yokohama, Japan
| | - Hirotsugu Uemura
- Department of Urology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yüksel Ürün
- Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey; Ankara University Cancer Research Institute, Ankara, Turkey
| | - Claire L Vale
- University College London, MRC Clinical Trials Unit at UCL, London, UK
| | - Inge van Oort
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Neha Vapiwala
- Department of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Jochen Walz
- Department of Urology, Institut Paoli-Calmettes Cancer Centre, Marseille, France
| | - Kosj Yamoah
- Department of Radiation Oncology & Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, University of South Florida, Tampa, FL, USA
| | - Dingwei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Evan Y Yu
- Department of Medicine, Division of Oncology, University of Washington and Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Almudena Zapatero
- Department of Radiation Oncology, Hospital Universitario de La Princesa, Health Research Institute, Madrid, Spain
| | - Thomas Zilli
- Radiation Oncology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Aurelius Omlin
- Onkozentrum Zurich, University of Zurich and Tumorzentrum Hirslanden Zurich, Switzerland
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Jindal R, Nanda A, Pillai M, Ware KE, Singh D, Sehgal M, Armstrong AJ, Somarelli JA, Jolly MK. Emergent dynamics of underlying regulatory network links EMT and androgen receptor-dependent resistance in prostate cancer. Comput Struct Biotechnol J 2023; 21:1498-1509. [PMID: 36851919 PMCID: PMC9957767 DOI: 10.1016/j.csbj.2023.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/23/2023] [Accepted: 01/23/2023] [Indexed: 02/10/2023] Open
Abstract
Advanced prostate cancer patients initially respond to hormone therapy, be it in the form of androgen deprivation therapy or second-generation hormone therapies, such as abiraterone acetate or enzalutamide. However, most men with prostate cancer eventually develop hormone therapy resistance. This resistance can arise through multiple mechanisms, such as through genetic mutations, epigenetic mechanisms, or through non-genetic pathways, such as lineage plasticity along epithelial-mesenchymal or neuroendocrine-like axes. These mechanisms of hormone therapy resistance often co-exist within a single patient's tumor and can overlap within a single cell. There exists a growing need to better understand how phenotypic heterogeneity and plasticity results from emergent dynamics of the regulatory networks governing androgen independence. Here, we investigated the dynamics of a regulatory network connecting the drivers of androgen receptor (AR) splice variant-mediated androgen independence and those of epithelial-mesenchymal transition. Model simulations for this network revealed four possible phenotypes: epithelial-sensitive (ES), epithelial-resistant (ER), mesenchymal-resistant (MR) and mesenchymal-sensitive (MS), with the latter phenotype occurring rarely. We observed that well-coordinated "teams" of regulators working antagonistically within the network enable these phenotypes. These model predictions are supported by multiple transcriptomic datasets both at single-cell and bulk levels, including in vitro EMT induction models and clinical samples. Further, our simulations reveal spontaneous stochastic switching between the ES and MR states. Addition of the immune checkpoint molecule, PD-L1, to the network was able to capture the interactions between AR, PD-L1, and the mesenchymal marker SNAIL, which was also confirmed through quantitative experiments. This systems-level understanding of the driver of androgen independence and EMT could aid in understanding non-genetic transitions and progression of such cancers and help in identifying novel therapeutic strategies or targets.
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Affiliation(s)
- Rashi Jindal
- Center for BioSystems Science and Engineering, Indian Institute of Science, Bangalore 560012, India.,Undergraduate Programme, Indian Institute of Science, Bangalore 560012, India
| | - Abheepsa Nanda
- Center for BioSystems Science and Engineering, Indian Institute of Science, Bangalore 560012, India.,Undergraduate Programme, Indian Institute of Science, Bangalore 560012, India
| | - Maalavika Pillai
- Center for BioSystems Science and Engineering, Indian Institute of Science, Bangalore 560012, India.,Undergraduate Programme, Indian Institute of Science, Bangalore 560012, India
| | - Kathryn E Ware
- Department of Medicine, Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, NC 27710, USA
| | - Divyoj Singh
- Center for BioSystems Science and Engineering, Indian Institute of Science, Bangalore 560012, India.,Undergraduate Programme, Indian Institute of Science, Bangalore 560012, India
| | - Manas Sehgal
- Center for BioSystems Science and Engineering, Indian Institute of Science, Bangalore 560012, India
| | - Andrew J Armstrong
- Department of Medicine, Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, NC 27710, USA.,Department of Surgery, Duke University, Durham, NC 27710, USA.,Department of Pharmacology and Cancer Biology, Duke University, Durham, NC 27710, USA
| | - Jason A Somarelli
- Department of Medicine, Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, NC 27710, USA
| | - Mohit Kumar Jolly
- Center for BioSystems Science and Engineering, Indian Institute of Science, Bangalore 560012, India
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Wang EC, Lee WR, Armstrong AJ. Second generation anti-androgens and androgen deprivation therapy with radiation therapy in the definitive management of high-risk prostate cancer. Prostate Cancer Prostatic Dis 2023; 26:30-40. [PMID: 36203051 PMCID: PMC10033329 DOI: 10.1038/s41391-022-00598-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 09/15/2022] [Accepted: 09/21/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evolving data suggest that men with high-risk localized prostate cancer may benefit from more potent androgen receptor inhibition in the context of curative intent radiotherapy. Recently updated American Society for Clinical Oncology (ASCO) evidence-based guidelines and the National Comprehensive Cancer Network (NCCN) Guidelines have updated recommendations for the consideration of adding second generation anti-androgens to androgen deprivation therapy (ADT) in men receiving radiation therapy (RT) for noncastrate locally advanced high and very high risk nonmetastatic or node positive prostate cancer. METHODS AND RESULTS We conducted a comprehensive review of existing published and abstract presented evidence behind RT with ADT for the definitive management of high-risk prostate cancer, particularly focused on the current phase II and III trial evidence for the addition of second generation anti-androgens to ADT in definitive RT treatment of high-risk prostate cancer and specifically focused on the recent STAMPEDE trial results with abiraterone acetate. We review the biological mechanisms in which second generation anti-androgens may help mitigate ADT resistance and provide radiosensitization through inhibition of DNA repair. Finally, we discuss ongoing clinical trials of potent androgen receptor (AR) inhibitors with ADT in this non-metastatic high-risk radiotherapy setting that may inform on future treatment guidelines. CONCLUSIONS Recent data suggest an overall survival benefit as well as increased probabilities of disease free and metastasis free survival in men with high and very high-risk localized, node positive, and oligometastatic hormone sensitive prostate cancer with abiraterone acetate and prednisone and support the use of potent AR inhibitors in this setting after informed decision making.
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Affiliation(s)
- Edina C Wang
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - W Robert Lee
- Department of Radiation Oncology, Duke University, Durham, NC, USA
| | - Andrew J Armstrong
- Division of Medical Oncology, Department of Medicine, Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, NC, USA.
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Broderick A, Li J, Chu A, Hwang C, Barata PC, Cackowski FC, Labriola M, Ghose A, Bilen MA, Kilari D, Graham L, Tripathi A, Garje R, Koshkin VS, Pan E, Dorff TB, McKay RR, Schweizer MT, Alva AS, Armstrong AJ. Clinical implications of Wnt signaling alterations in patients (pts) with advanced prostate cancer (aPC). J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
229 Background: Aberrant Wnt signaling has been implicated in prostate cancer tumorigenesis, progression, and metastasis in preclinical models. While studies have identified recurrent molecular alterations in the Wnt signaling components in about 20% of aPC pts, the clinical significance of these alterations has been incompletely characterized. Methods: PROMISE is a multi-institutional, retrospective, clinical-genomic database - inclusive of aPC pts who had tissue and/or blood-based genomic testing by commercially available CLIA-certified platforms. We evaluated outcomes in pts with alterations leading to the activation of the canonical Wnt pathway, specifically activating mutations in CTNNB1 or RSPO2 or inactivating mutations in APC, RNF43, or ZNRF3 (Wnt altered), compared to those lacking such alterations (Wnt wild type). Multiple endpoints were evaluated, including the frequency of metastatic disease to different sites and co-occurring alterations. Results: 1596 pts with aPC were included with a median age of 63 years at diagnosis. Wnt pathway alterations were identified in 12.4% (198/1596). Wnt altered pts had a statistically significant increase in liver and lung metastases compared with Wnt wild type pts at diagnosis (4.5% vs 2.1%, p=0.0438; 6.1% vs 2.9%, p=0.0292), at first metastatic disease (11.6% vs 5.4%, p= 0.0015; 14.8% vs 6.6%, p<0.0001), and at diagnosis of CRPC (14.2% vs 7.9%, p=0.01436; 16.1% vs 6.8%, p=0.0003). Fewer Wnt altered pts had bone metastases at CRPC compared with wild type pts (67.7% vs 75.2%, p=0.04948) without significant difference of bone metastases at the time of diagnosis or at the time of first metastatic disease. The frequency of metastases to other sites was similar between the cohorts. More Wnt altered pts had ductal features on histology at diagnosis compared with Wnt wild type pts (4.0% v 1.6%, p=0.02415) without difference in PSA, Gleason score, TNM stage, or presence of neuroendocrine or intraductal features. Co-occurring genomic alterations that were more common in Wnt altered pts included PTEN loss/mutation (25.3% vs 18.3%, p=0.0270), RB1 loss/mutation (10.6% vs 5.8%, p=0.0079), AR mutations or gain (37.9% vs 24.0%, p< 0.0001), and SPOP mutations (14.1% vs 3.9%, p< 0.0001) as compared with Wnt wild type pts. Conclusions: Wnt pathway alterations were associated with ductal histology, an increase in visceral metastases at all time points evaluated, and an increase in co-occurring PTEN, RB1, AR, and SPOP alterations. The clinical heterogeneity of aPC and differences in co-occurring mutations between the cohorts make isolating the effect of alterations in a single pathway challenging. Analysis of overall survival outcomes is currently in process, and future multivariable analysis is planned to adjust for established clinical factors and co-occurring mutations to identify the independent contributions of Wnt alterations to clinical outcomes.
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Affiliation(s)
- Amanda Broderick
- Division of Medical Oncology, Duke University Medical Center, Duke Cancer Institute, Duke University, Durham, NC
| | - Jinju Li
- Rogel Cancer Center, Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | - Alec Chu
- Pathology Department, University of Michigan, Ann Arbor, MI
| | - Clara Hwang
- Division of Hematology/Oncology, Department of Internal Medicine, Henry Ford Cancer Institute, Detroit, MI
| | - Pedro C. Barata
- Department of Internal Medicine, University Hospitals Seidman Cancer Center, Cleveland, OH
| | | | - Matthew Labriola
- Division of Medical Oncology, Duke University Medical Center, Duke Cancer Institute, Duke University, Durham, NC
| | - Alyssa Ghose
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI
| | | | - Deepak Kilari
- Department of Medicine, Medical College of Wisconsin Cancer Center, Medical College of Wisconsin, Milwaukee, WI
| | - Laura Graham
- University of Colorado Cancer Center Anschutz Medical Campus, Aurora, CO
| | - Abhishek Tripathi
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Rohan Garje
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - Vadim S Koshkin
- Division of Hematology and Oncology, Department of Medicine,University of California San Francisco, San Francisco, CA
| | - Elizabeth Pan
- Moores Cancer Center, University of California San Diego, La Jolla, CA
| | - Tanya B. Dorff
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Rana R. McKay
- Moores Cancer Center, University of California San Diego, La Jolla, CA
| | | | - Ajjai Shivaram Alva
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI
| | - Andrew J. Armstrong
- Division of Medical Oncology, Duke University Medical Center, Duke Cancer Institute, Duke University, Durham, NC
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Clarke NW, Armstrong AJ, Thiery-Vuillemin A, Oya M, Shore ND, Procopio G, Guedes JDC, Arslan C, Mehra N, Parnis F, Brown E, Schlürmann F, Joung JY, Sugimoto M, Sartor AO, Liu YZ, Poehlein CH, Barker L, del Rosario PM, Saad F. Final overall survival (OS) in PROpel: Abiraterone (abi) and olaparib (ola) versus abiraterone and placebo (pbo) as first-line (1L) therapy for metastatic castration-resistant prostate cancer (mCRPC). J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.lba16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
LBA16 Background: PROpel (NCT03732820) met its primary endpoint showing significant investigator-assessed radiographic progression-free survival (rPFS) benefit for patients with mCRPC treated with abi + ola vs abi + pbo in the 1L setting (hazard ratio [HR] 0.66, 95% confidence interval [CI] 0.54–0.81, P< 0.001, data cut-off: 7/30/2021). Sensitivity analysis by blinded independent central review was consistent. A trend toward OS benefit with abi + ola was observed at the time of the primary rPFS analysis (28.6% maturity, HR 0.86, 95% CI 0.66–1.12) and a subsequent interim analysis (40.1% maturity, HR 0.83, 95% CI 0.66–1.03). We report OS and safety from the pre-planned final analysis (data cut-off: 10/12/2022). Methods: PROpel is a randomized, double-blind phase 3 trial of 1L therapy for patients with mCRPC eligible for abiraterone. Patients were prospectively assessed for homologous recombination repair mutation (HRRm) status using tumor tissue (FoundationOne CDx) and/or circulating tumor DNA (ctDNA; FoundationOne Liquid CDx) tests after randomization 1:1 to ola (300 mg twice daily [bid]) or pbo, and abi (1000 mg once daily) plus prednisone/prednisolone (5 mg bid). Treatment continued until radiographic disease progression, unacceptable toxicity or withdrawal of consent. OS was a key secondary endpoint (2-sided boundary for significance 0.0377). Aggregate results from tumor tissue and ctDNA tests were used to assign patients to HRRm/BRCAm subgroups. Results: Patient (n = 796) characteristics (including prior docetaxel, site of metastasis, symptom score and HRRm status) were generally balanced. There was a consistent trend toward OS benefit in the intention-to-treat (ITT) population with abi + ola vs abi + pbo (maturity 47.9%, HR 0.81, 95% CI 0.67–1.00, P= 0.0544), with median OS 42.1 months (m) vs 34.7 m, respectively. OS medians and HRs for HRRm, non-HRRm, BRCAm and non-BRCAm subgroups all favored abi + ola vs abi + pbo. In the abi + ola arm the most common Grade ≥3 adverse event was anemia (16.1%). Conclusions: At the prespecified final analysis in PROpel, abi + ola prolonged OS by > 7 m vs standard-of-care abiraterone (abi + pbo) in the ITT population. The median OS of > 42 m is the longest median reported to date in a phase 3 trial in 1L mCRPC. Consistent with rPFS results, a trend toward OS benefit was observed in HRRm, non-HRRm, BRCAm and non-BRCAm subgroups with greatest benefit in the BRCAm subgroup. No new long-term safety issues were identified. These results support the use of abi + ola in 1L mCRPC. Clinical trial information: NCT03732820 . [Table: see text]
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Affiliation(s)
- Noel W. Clarke
- The Christie and Salford Royal NHS Foundation Trusts, Manchester, United Kingdom
| | - Andrew J. Armstrong
- Duke Cancer Institute Center for Prostate and Urologic Cancer, Duke University, Durham, NC
| | | | | | | | | | | | - Cagatay Arslan
- İzmir Economy University Medical Park Hospital, Karsiyaka, Turkey
| | - Niven Mehra
- Radboud Universitair Medisch Centrum, Nijmegen, Netherlands
| | - Francis Parnis
- Ashford Cancer Centre Research, Kurralta Park, SA, Australia
| | - Emma Brown
- University Hospital Southampton, Southampton, United Kingdom
| | | | | | | | | | - Yu-Zhen Liu
- Precision Medicine, Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | | | - Laura Barker
- Global Medicines Development, Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | | | - Fred Saad
- Centre Hospitalier de l’Université de Montréal/CRCHUM, Université de Montreal, Montreal, QC, Canada
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Petrylak DP, Ratta R, Matsubara N, Korbenfeld EP, Gafanov R, Mourey L, Todenhöfer T, Gurney H, Kramer G, Bergman AM, Zalewski P, De Santis M, Armstrong AJ, Gerritsen WR, Pachynski RK, Saretsky TL, Ghate SR, Li XT, Schloss C, Fizazi K. Patient-reported outcomes (PROs) in KEYNOTE-921: Pembrolizumab (pembro) plus docetaxel for patients (pts) with metastatic castration-resistant prostate cancer (mCRPC). J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
129 Background: The double-blind, phase 3, randomized KEYNOTE-921 trial (NCT03834506) showed that pembro + docetaxel did not significantly improve rPFS or OS for pts with mCRPC treated with prior next-generation hormonal agent (NHA) therapy. We present PROs for pembro + docetaxel vs placebo + docetaxel in KEYNOTE-921. Methods: Pts were randomly assigned 1:1 to receive pembro 200 mg or placebo IV Q3W (≤35 cycles) + docetaxel 75 mg/m2 IV Q3W (≤10 cycles) and prednisone 5 mg orally BID. PROs were evaluated in pts who received ≥1 dose of study treatment and had ≥1 PRO assessment. FACT-P and BPI-SF were administered at baseline, Q3W until wk 24, Q6W until wk 72, then Q12W for ≤2 y. A prespecified secondary end point was time to pain progression (TTPP) based on BPI-SF. Prespecified exploratory end points included least squares mean (LSM) change from baseline to wk 27 for FACT-P total and subscale scores (FACT-G total, TOI, FAPSI-6, FWB, PWB, and PCS) and wk 24 for BPI-SF scores (pain interference, pain severity, and worst pain), and time to deterioration (TTD) and overall improvement rate in FACT-P total and subscale scores. Differences were evaluated using 2-sided nominal P values not controlled for multiplicity. Results: Of 1030 pts enrolled, the PRO analysis population included 1028 (n = 514 in each arm). At the prespecified final analysis, median time from randomization to data cutoff of June 20, 2022, was 22.7 mo (range, 12.1-36.7). Completion rates for FACT-P and BPI-SF were >78% at baseline, >65% for FACT-P at wk 27, and >63% for BPI-SF at wk 24. Median TTPP was 21.1 mo (95% CI, 13.7-NR) for pembro + docetaxel vs NR (95% CI, 13.8-NR) for placebo + docetaxel (HR, 1.05 [95% CI, 0.77-1.43]). No LSM differences were observed in FACT-P total scores with pembro + docetaxel (–5.31 [95% CI, –7.02 to –3.61]) vs placebo + docetaxel (–3.89 [95% CI, –5.59 to –2.19]) or BPI-SF scores. Median TTD in FACT-P total scores was 21.8 mo (95% CI, 20.0-NR) for pembro + docetaxel and NR (95% CI, 11.1-NR) for placebo + docetaxel (HR, 1.09 [95% CI, 0.88-1.35]). No differences were observed for TTD in FACT-G total, TOI, FAPSI-6, FWB, PWB, and PCS scores between groups. A numerically lower proportion of pts receiving pembro + docetaxel (39.9%) had improved + stable FACT-P total scores compared with placebo + docetaxel (45.3%). FACT-P and BPI-SF scores were generally maintained across all evaluated time points up to wk 81. Conclusions: HRQoL and disease-related symptom scores at all analyzed time points, as well as TTD and TTPP, were similar between the 2 trial arms. These data suggest that pembro + docetaxel did not negatively impact QoL in pts with mCRPC treated with prior NHA. Clinical trial information: NCT03834506 . [Table: see text]
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Affiliation(s)
| | | | | | | | - Rustem Gafanov
- Russian Scientific Center of Roentgenoradiology, Moscow, Russian Federation
| | - Loic Mourey
- Institut Claudius Regaud IUCT Oncopole, Toulouse, France
| | | | | | - Gero Kramer
- Medizinische Universität Wien, Vienna, Austria
| | | | | | | | - Andrew J. Armstrong
- Duke Cancer Institute Center for Prostate and Urologic Cancer, Duke University, Durham, NC
| | | | | | | | | | | | | | - Karim Fizazi
- Gustave Roussy, University of Paris-Saclay, Villejuif, France
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Paller CJ, Lorentz J, Appleman LJ, Armstrong AJ, Barata PC, Dreicer R, Elrod JA, Fleming MT, George CM, Heath EI, Hussain MHA, Mao SS, McKay RR, Morgans AK, Orton M, Pili R, Saraiya B, Sokolova A, Stadler WM, Cheng HH. PROMISE Registry: A prostate cancer registry of outcomes and germline mutations for improved survival and treatment effectiveness. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.tps274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
Abstract
TPS274 Background: Recent updates to genetic testing recommendations and approved treatment options for prostate cancer (PCa) patients (pts) have clarified the need for comprehensive genetic registries. Germline DNA damage repair (DDR) defects are present in over 10% of pts who develop metastatic castration-resistant prostate cancer (mCRPC) while 5-10% pts with localized PCa have germline pathogenic variants in DDR genes. NCCN guidelines have recently expanded to address genetic testing to include high risk localized, node positive and metastatic disease, in addition to family cancer history criteria. In May 2020, the FDA approved 2 PARP inhibitors for mCRPC treatment. Genetic registries can address the critical need to identify pts for recently approved targeted treatments, understand real-world effects of targeted therapies, and expand clinical trials examining less common mutations. PROMISE is a prospective genetic registry equipped to meet these needs. Methods: 5000 PCa pts will be screened via the online study portal and at-home germline testing to identify and enroll 500 eligible pts with germline pathogenic variants, likely pathogenic variants, and variants of uncertain significance (VUS) in the genes of interest: ATM, ATR, BARD1, BRCA1, BRCA2, BRIP1, CHEK2, FAM175A, GEN1, HOXB13, MRE11A, MLH1, MSH2, MSH6, PALB2, PMS2, PTEN, RAD51C, RAD51D, TP53 and XRCC2. Additional genes may be added as evidence emerges. Eligible pts must be assigned male at birth and have documented PCa through tissue biopsy, and/or PSA >100ng/dL, and/or radiographic evidence of disease. Pts with or without prior genetic testing, including those with known pathogenic variants, are encouraged to enroll. Exclusion criteria are: inability or unwillingness to provide information for eligibility and incomplete inclusion criteria. Following germline testing, pts will be offered genetic counseling and periodic newsletters with updates on treatments and clinical trials. Every 6 months, eligible pts will complete a patient-reported outcome (PRO) survey (EORTC QLQ-C30) and updated medical records will be obtained for clinical data abstraction. Eligible pts will enter long-term follow-up. The primary endpoint is the creation of a prospective genetic registry of PCa pts. Additional endpoints include: frequency of pathogenic or likely pathogenic germline variants of interest, recruitment of a control group with a VUS in the genes of interest, association between disease characteristics and germline testing results, comparison of PROs between disease subpopulations, longitudinal outcomes, and overall survival. Study duration is 20 years (recruitment: 5 years, follow-up: 15 years). PROMISE is recruiting at 23 US sites. 1829 subjects have enrolled in the screening phase with 189 eligible for long-term follow-up. PROMISE is sponsored and managed by the Prostate Cancer Clinical Trials Consortium. Clinical trial information: NCT04995198 .
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Affiliation(s)
- Channing Judith Paller
- Department of Medical Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | - Andrew J. Armstrong
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University School of Medicine, Durham, NC
| | - Pedro C. Barata
- Department of Internal Medicine, University Hospitals Seidman Cancer Center, Cleveland, OH
| | - Robert Dreicer
- University of Virginia School of Medicine, Charlottesville, VA
| | | | | | | | - Elisabeth I. Heath
- Karmanos Cancer Institute, Department of Oncology, Wayne State University School of Medicine, Detroit, MI
| | - Maha H. A. Hussain
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | - Shifeng S. Mao
- Allegheny Health Network Cancer Institute - AGH, Pittsburgh, PA
| | - Rana R. McKay
- Moores Cancer Center, University of California San Diego, La Jolla, CA
| | | | - Matthew Orton
- Indiana University Health Arnett Cancer Center, Lafayette, IN
| | - Roberto Pili
- University at Buffalo Department of Medicine, Buffalo, NY
| | - Biren Saraiya
- Rutgers Cancer Institue of New Jersey, New Brunswick, NJ
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Taylor AK, Sperger JM, Sharifi MN, Shi Y, Stahlfeld C, Schehr JL, Emamekhoo H, Kyriakopoulos C, Armstrong AJ, Wei XX, Taplin ME, McKay RR, Zhao S, Lang JM. Association of emergent neuroendocrine prostate cancer detected by liquid biopsies with survival and treatment resistance. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
247 Background: The mainstay of therapy in metastatic prostate cancer is androgen receptor (AR) signaling inhibition. However, the emergence of early castration resistance or neuroendocrine transformation is associated with poor prognosis. Reliable biomarkers are needed to identify these patients and guide selection of clinical therapy. Methods: mRNA was isolated from EpCAM-positive circulating tumor cells (CTCs) isolated from patients with CSPC, CRPC, or NEPC to measure expression of KLK2, KLK3 (PSA), TMPRSS2, FOLH1 (PSMA), synaptophysin ( SYP), and chromogranin ( CHGA). Post-hoc retrospective analysis of an institutional review board–approved prospective cohort (N = 98) was performed to identify patterns of gene expression. Samples were considered AR+ if 3 of 4 AR pathway genes ( TMPRSS2, KLK2, KLK3, and FOLH1) were positive, and were considered NE+ if either or both SYP or CHGA were positive. Blood samples from two prospective clinical trials of men with mCRPC treated with abiraterone and enzalutamide, respectively, were analyzed to confirm results. Longitudinal samples were collected from 17 patients (6 NEPC and 11 Adenocarcinoma) and cell free DNA was isolated and sequenced using a novel targeted exon panel. Results: AR and/or NE positive patients were found to have a median overall survival (OS) of 8.58 months as compared to a median OS of 29.6 months in the AR and NE negative population (p<0.0001; HR=2.75 [1.60-4.56]). In the subset of castrate resistant prostate cancer (CRPC) patients, AR+ and/or NE+ patients (n=31) were found to have a median OS of 6.74 months vs 18.79 months in the AR- and NE- group (n=39) (p= 0.0009; HR 2.38 [1.36-4.18]). We also tested samples from a phase II ARSI trials with abiraterone and enzalutamide, respectively. None of the baseline samples from these two trials met the above criteria for NEPC (AR- NE+) on their CTCs or histologically. Three of 48 total patients were identified with expression in their baseline blood samples without loss of AR target gene expression (AR+/NE+). Preliminary analysis of this small patient cohort in comparison to patients who were NE- shows that NE+ patients had worse OS (HR= 5.5906 [1.143-27.36), as would be expected by patients with emerging neuroendocrine differentiation. Integrated ctDNA sequencing identified mutations in genes associated with NEPC. Conclusions: The expression of NE genes in liquid biopsies while retaining AR target gene expression is associated with worse OS and may indicate the transition to neuroendocrine differentiation, with clinical characteristics consistent with this phenotype. Early identification of these patients may improve therapeutic decisions and improved patient outcomes. Pairing genomic alteration with changes in gene expression may additionally offer the basis for a new mechanism to assess efficacy of novel therapeutics in future clinical trials.
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Affiliation(s)
- Amy K Taylor
- Carbone Cancer Center, University of Wisconsin, Madison, WI
| | | | | | - Yue Shi
- Department of Human Oncology, University of Wisconsin, Madison, WI
| | | | | | | | | | - Andrew J. Armstrong
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, NC
| | - Xiao X. Wei
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Rana R. McKay
- Moores Cancer Center, University of California San Diego, La Jolla, CA
| | - Shuang Zhao
- Department of Human Oncology, University of Wisconsin, Madison, WI
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Petrylak DP, Ratta R, Matsubara N, Korbenfeld EP, Gafanov R, Mourey L, Todenhöfer T, Gurney H, Kramer G, Bergman AM, Zalewski P, De Santis M, Armstrong AJ, Gerritsen WR, Pachynski RK, Byun SS, Li XT, Schloss C, Poehlein CH, Fizazi K. Pembrolizumab plus docetaxel for patients with metastatic castration-resistant prostate cancer (mCRPC): Randomized, double-blind, phase 3 KEYNOTE-921 study. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
19 Background: Docetaxel is a treatment option following disease progression on a next-generation hormonal agent (NHA) for patients with mCRPC, but there is an urgent need for more efficacious treatments. The randomized, double-blind, phase 3 KEYNOTE-921 study (NCT03834506) evaluated the efficacy and safety of pembrolizumab + docetaxel vs placebo + docetaxel for participants (pts) with mCRPC who had received prior NHA therapy. Methods: Eligible pts were ≥18 years old, had mCRPC that progressed on androgen deprivation therapy, had received 1 prior NHA, and had an ECOG performance status of 0 or 1. Pts were randomized 1:1 to receive 200 mg pembrolizumab Q3W or placebo for ≤35 cycles (~2 years) in combination with 75 mg/m2 docetaxel Q3W for ≤10 cycles and 5 mg prednisone BID. The dual primary endpoints were radiographic progression-free survival (rPFS; tested at first interim analysis) per PCWG-modified RECIST 1.1 by blinded independent central review and overall survival (OS; tested at final analysis). The key secondary endpoint was time to initiation of the first subsequent anticancer therapy (TFST; at first interim analysis). Safety was one of the secondary endpoints. Results: Between May 30, 2019 and June 17, 2021, 1030 pts were randomized to receive pembrolizumab + docetaxel (n=515) or placebo + docetaxel (n=515). The median (range) time from randomization to data cutoff date of June 20, 2022 at final analysis was 22.7 mo (12.1−36.7). Baseline characteristics were generally balanced between arms; approximately half of pts in each arm had received prior abiraterone. Pts in the pembrolizumab + docetaxel arm received a median (range) of 12 (1–35) cycles of pembrolizumab and 9 (1–12) cycles of docetaxel; pts in the placebo + docetaxel arm received a median (range) of 12 (1–35) cycles of placebo and 9 (1–10) cycles of docetaxel. The dual primary endpoints of rPFS (median 8.6 mo with pembrolizumab + docetaxel vs 8.3 mo with placebo + docetaxel; HR 0.85, 95% CI 0.71−1.01; P=0.0335) and OS (median 19.6 mo vs 19.0 mo; HR 0.92, 95% CI 0.78−1.09; P=0.1677) were not met. Median TFST was 10.7 mo vs 10.4 mo, respectively (HR 0.86, 95% CI 0.74−1.01). Treatment-related AEs occurred in 94.6% (grade ≥3 in 43.2%) and 94.9% (grade ≥3 in 36.6%) of pts with pembrolizumab + docetaxel vs placebo + docetaxel. 2 treatment-related deaths with pembrolizumab + docetaxel and 7 with placebo + docetaxel were reported. Immune-mediated AEs and infusion reactions occurred in 23.3% (grade ≥3 in 6.2%) and 12.3% (grade ≥3 in 1.2%) of pts with pembrolizumab + docetaxel vs placebo + docetaxel, most commonly pneumonitis (7.0% vs 3.1%) and hypothyroidism (6.4% vs 3.3%). Conclusions: The addition of pembrolizumab to docetaxel did not significantly improve rPFS or OS for pts with mCRPC and did not result in a notable increase in treatment-related AEs. Clinical trial information: NCT03834506 .
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Affiliation(s)
| | | | | | | | - Rustem Gafanov
- Russian Research Centre of Roentgen Radiology, Moscow, Russian Federation
| | - Loic Mourey
- Institut Claudius Regaud IUCT Oncopole, Toulouse, France
| | | | - Howard Gurney
- MQ Health Macquarie University Health Sciences Centre, Macquarie Park, Australia
| | - Gero Kramer
- Medizinische Universitaet Wien, Vienna, Austria
| | - Andre M. Bergman
- Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | | | | | - Andrew J. Armstrong
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, NC
| | | | | | - Seok-Soo Byun
- Seoul National University Bundang Hospital, Seoul, South Korea
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Brown LC, Armstrong AJ. Germline Testing in Prostate Cancer: Implementation and Disparities of Care. JCO Oncol Pract 2023; 19:221-223. [PMID: 36720077 DOI: 10.1200/op.22.00804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
| | - Andrew J Armstrong
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, NC
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Broderick A, Labriola MK, Shore N, Armstrong AJ. Foreign accent syndrome as a heralding manifestation of transformation to small cell neuroendocrine prostate cancer. BMJ Case Rep 2023; 16:16/1/e251655. [PMID: 36717160 PMCID: PMC9887694 DOI: 10.1136/bcr-2022-251655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
A man in his 50s with metastatic hormone-sensitive prostate cancer, receiving androgen deprivation therapy and abiraterone acetate/prednisone, presented with an uncontrollable 'Irish brogue' accent despite no Irish background, consistent with foreign accent syndrome (FAS). He had no neurological examination abnormalities, psychiatric history or MRI of the brain abnormalities at symptom onset. Imaging revealed progression of his prostate cancer, despite undetectable prostate-specific antigen levels. Biopsy confirmed transformation to small cell neuroendocrine prostate cancer (NEPC). Despite chemotherapy, his NEPC progressed resulting in multifocal brain metastases and a likely paraneoplastic ascending paralysis leading to his death. We report FAS as the presenting manifestation of transformation to small cell NEPC, a previously undescribed phenomenon. His presentation was most consistent with an underlying paraneoplastic neurological disorder (PND), despite a negative serum paraneoplastic panel. This report enhances the minimal existing literature on FAS and PNDs associated with transformed NEPC.
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Affiliation(s)
- Amanda Broderick
- Department of Internal Medicine, Duke University Health System, Durham, North Carolina, USA
| | - Matthew K Labriola
- Division of Medical Oncology, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Neal Shore
- Carolina Urologic Research Center, Myrtle Beach, South Carolina, USA
| | - Andrew J Armstrong
- Divisions of Medical Oncology and Urology, Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, North Carolina, USA
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Gratzke C, Kwiatkowski M, De Giorgi U, Martins da Trindade K, De Santis M, Armstrong AJ, Niu C, Liu Y, Poehlein CH. KEYNOTE-991: pembrolizumab plus enzalutamide and androgen deprivation for metastatic hormone-sensitive prostate cancer. Future Oncol 2023; 18:4079-4087. [PMID: 36705526 DOI: 10.2217/fon-2022-0776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Current treatment for patients with metastatic hormone-sensitive prostate cancer (mHSPC) delays disease progression and improves survival, but resistance is inevitable. Additional therapies that prolong survival are needed. Androgen deprivation therapy (ADT) combined with next-generation hormonal agents, such as enzalutamide, is standard-of-care for men with mHSPC. Emerging evidence suggests potential synergism between enzalutamide and the PD-1 inhibitor pembrolizumab in prostate cancer. The phase III randomized, placebo-controlled, double-blind KEYNOTE-991 trial will investigate the efficacy and safety of pembrolizumab versus placebo in combination with enzalutamide when initiating ADT in participants with mHSPC naive to next-generation hormonal agents. Approximately 1232 patients will be randomly assigned 1:1 to receive pembrolizumab 200 mg every 3 weeks or placebo every 3 weeks, both with enzalutamide 160 mg once daily and ADT. Dual primary end points are overall survival and radiographic progression-free survival. Secondary end points include time to first subsequent therapy, time to symptomatic skeletal related event, objective response rate and safety and tolerability. Clinical Trial Registration: NCT04191096 (ClinicalTrials.gov).
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Affiliation(s)
- Christian Gratzke
- Department of Urology, University Hospital Freiburg, Hugstetterstr. 55, Freiburg, 79106, Germany
| | - Mariusz Kwiatkowski
- Szpital Wojewodzki im Mikolaja Kopernika, Chałubińskiego 7, Koszalin, 75-581, Poland
| | - Ugo De Giorgi
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Via Piero Maroncelli, 40, Meldola, 47014, Italy
| | | | - Maria De Santis
- Charite Universitaetsmedizin, Charitépl. 1, Berlin, 10117, Germany
- Department of Urology, Medical University of Vienna, Spitalgasse 23, Vienna, 1090, Austria
| | - Andrew J Armstrong
- Duke Cancer Institute Center for Prostate & Urologic Cancers, Duke University, 20 Duke Medicine Cir, Durham, NC 27710, USA
| | - Cuizhen Niu
- MSD China, Plot B-12, Electronic City West Zone, Chaoyang District, Beijing, 100012, China
| | - Yingjie Liu
- Merck & Co., Inc., 90 E Scott Ave, Rahway, NJ 07065, USA
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Berger BT, Labriola MK, Antonarakis ES, Armstrong AJ. Response to bipolar androgen therapy and PD-1 inhibition in a patient with metastatic castration-resistant prostate cancer and a germline CHEK2 mutation. BMJ Case Rep 2023; 16:16/1/e251320. [PMID: 36653039 PMCID: PMC9853129 DOI: 10.1136/bcr-2022-251320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
We present the case of a patient with germline CHEK2-mutated metastatic castration-resistant prostate cancer (mCRPC) who responded to bipolar androgen therapy (BAT) combined with pembrolizumab after progressing through multiple lines of therapy. The patient was diagnosed in his 40s following an elevated screening prostate-specific antigen and biopsy. Over the course of 20 years, he progressed through nearly all standard therapies including androgen deprivation, combined androgen blockade, traditional chemotherapy, targeted therapies and experimental agents. He was ultimately treated with BAT, whereby the patient's cycle was between low (castrate) and high (supraphysiological) testosterone levels. This counterintuitive approach resulted in a marked response to BAT plus pembrolizumab consolidation lasting 13 months. His underlying germline mutation in CHEK2, an important mediator of DNA repair, may have sensitised the cancer cells to the DNA damage caused by BAT. Single case report outcomes should not be used as evidence of efficacy for treatment regimes. Our case supports further investigation into BAT plus immunotherapy for patients with DNA repair-deficient mCRPC.
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Affiliation(s)
- Benjamin T Berger
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Matthew K Labriola
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.,Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, North Carolina, USA
| | - Emmanuel S Antonarakis
- Department of Medicine, Division of Hematology, Oncology and Transplantation, University of Minnesota Academic Health Center, Minneapolis, Minnesota, USA
| | - Andrew J Armstrong
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA .,Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, North Carolina, USA
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Green MF, Watson CH, Tait S, He J, Pavlick DC, Frampton G, Riedel J, Plichta JK, Armstrong AJ, Previs RA, Kauff N, Strickler JH, Datto MB, Berchuck A, Menendez CS. Concordance Between Genomic Alterations Detected by Tumor and Germline Sequencing: Results from a Tertiary Care Academic Center Molecular Tumor Board. Oncologist 2023; 28:33-39. [PMID: 35962742 PMCID: PMC9847540 DOI: 10.1093/oncolo/oyac164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 07/15/2022] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The majority of tumor sequencing currently performed on cancer patients does not include a matched normal control, and in cases where germline testing is performed, it is usually run independently of tumor testing. The rates of concordance between variants identified via germline and tumor testing in this context are poorly understood. We compared tumor and germline sequencing results in patients with breast, ovarian, pancreatic, and prostate cancer who were found to harbor alterations in genes associated with homologous recombination deficiency (HRD) and increased hereditary cancer risk. We then evaluated the potential for a computational somatic-germline-zygosity (SGZ) modeling algorithm to predict germline status based on tumor-only comprehensive genomic profiling (CGP) results. METHODS A retrospective chart review was performed using an academic cancer center's databases of somatic and germline sequencing tests, and concordance between tumor and germline results was assessed. SGZ modeling from tumor-only CGP was compared to germline results to assess this method's accuracy in determining germline mutation status. RESULTS A total of 115 patients with 146 total alterations were identified. Concordance rates between somatic and germline alterations ranged from 0% to 85.7% depending on the gene and variant classification. After correcting for differences in variant classification and filtering practices, SGZ modeling was found to have 97.2% sensitivity and 90.3% specificity for the prediction of somatic versus germline origin. CONCLUSIONS Mutations in HRD genes identified by tumor-only sequencing are frequently germline. Providers should be aware that technical differences related to assay design, variant filtering, and variant classification can contribute to discordance between tumor-only and germline sequencing test results. In addition, SGZ modeling had high predictive power to distinguish between mutations of somatic and germline origin without the need for a matched normal control, and could potentially be considered to inform clinical decision-making.
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Affiliation(s)
- Michelle F Green
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Catherine H Watson
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
| | - Sarah Tait
- Duke University, School of Medicine, Durham, NC, USA
| | - Jie He
- Foundation Medicine, Inc., Cambridge, MA, USA
| | | | | | - Jinny Riedel
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | | | - Andrew J Armstrong
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham NCUSA
| | - Rebecca A Previs
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
| | - Noah Kauff
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - John H Strickler
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA,Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Michael B Datto
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Andrew Berchuck
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
| | - Carolyn S Menendez
- Corresponding author: Carolyn S. Menendez, MD, Duke Cancer Center, 216 Ashville Ave Ste 20, Cary, NC 27518, USA. E-mail:
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Armstrong AJ, Rosbrook B, Yamada S. Reply to R. Sun et al. J Clin Oncol 2022; 40:4279-4280. [PMID: 35985006 DOI: 10.1200/jco.22.01470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Andrew J Armstrong
- Andrew J. Armstrong, MD, ScM, Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, NC; Brad Rosbrook, MS, Pfizer Inc, New York, NY; and Shunsuke Yamada, MEng, Astellas Pharma Inc, Northbrook, IL
| | - Brad Rosbrook
- Andrew J. Armstrong, MD, ScM, Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, NC; Brad Rosbrook, MS, Pfizer Inc, New York, NY; and Shunsuke Yamada, MEng, Astellas Pharma Inc, Northbrook, IL
| | - Shunsuke Yamada
- Andrew J. Armstrong, MD, ScM, Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, NC; Brad Rosbrook, MS, Pfizer Inc, New York, NY; and Shunsuke Yamada, MEng, Astellas Pharma Inc, Northbrook, IL
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Kang Y, Armstrong AJ, Hsu DS. An autologous humanized patient-derived xenograft (PDX) model for evaluation of nivolumab immunotherapy in renal cell cancer: a case report. Stem Cell Investig 2022; 9:8. [PMID: 36393918 PMCID: PMC9659479 DOI: 10.21037/sci-2022-029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022]
Abstract
Background There is an unmet need for developing faithful animal models for preclinical evaluation of immunotherapy. The current approach to generate preclinical models for immunotherapy evaluation has been to transplant CD34+ cells from umbilical cord blood into immune-deficient mice followed by implantation of patient derived tumor cells. However, current models are associated with high tumor rejection rate secondary to the allograft vs. tumor response from human leukocyte antigen (HLA) mismatches. We herein report the first development of a novel, humanized patient-derived xenograft (PDX) model using autologous CD34+ cells from bone marrow aspirate obtained from a patient with metastatic clear cell renal cell carcinoma (mRCC) from whom a PDX had been developed. Case Description This is a 68-year-old Caucasian man diagnosed with mRCC with metastasis to the liver in 2014. He was treated with sunitinib +/− AGS-003 and underwent a cytoreductive right nephrectomy, left adrenalectomy and partial liver resection. PDX was generated using resected nephrectomy specimen. After surgery, patient received multiple lines of standard of care therapy including sunitinib, axitinib, bevacizumab, everolimus and cabozantinib. While progressing on cabozantinib, he was treated with nivolumab. Seven years after initiation of nivolumab, and 4 years after stopping systemic therapy, he remains in complete remission. To generate autologous PDX model, bone marrow aspirate was performed and CD34+ hematopoietic stem/progenitor cells (HSPCs) were isolated and injected into 150 rad irradiated non-obese diabetic scid gamma null (NSG) mice. At 11 weeks post-transplant, the matched patient PDX was injected subcutaneously into the humanized mice and the mice were treated with nivolumab. Conclusions Our case represents successful therapy of nivolumab in mRCC. Furthermore, HPSCs obtained from a single bone marrow aspirate were able to reconstitute an immune system in the mice that allowed nivolumab to inhibit the tumor growth of PDX and recapitulated the durable remission observed in the patient with nivolumab. We observed the reconstitution of human T cells, B cells and natural killer (NK) cells and unlike the humanized mouse model using cord blood, our model system eliminates the tumor rejection from mis-matched HLA. Our autologous humanized renal cell carcinoma (RCC) PDX model provides an effective tool to study immunotherapy in a preclinical setting.
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Affiliation(s)
- Yubin Kang
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Andrew J. Armstrong
- Divisions of Medical Oncology and Urology, Departments of Medicine, Surgery, and Pharmacology and Cancer Biology, Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University Medical Center, Durham, NC, USA
| | - David S. Hsu
- Divisions of Medical Oncology and Urology, Departments of Medicine, Surgery, and Pharmacology and Cancer Biology, Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University Medical Center, Durham, NC, USA
- Center for Genomics and Computational Biology, Duke University, Durham, NC, USA
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Kotamarti S, Armstrong AJ, Polascik TJ, Moul JW. Molecular Mechanisms of Castrate-Resistant Prostate Cancer. Urol Clin North Am 2022; 49:615-626. [DOI: 10.1016/j.ucl.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Zhao SG, Sperger JM, Schehr JL, McKay RR, Emamekhoo H, Singh A, Schultz ZD, Bade RM, Stahlfeld CN, Gilsdorf CS, Hernandez CI, Wolfe SK, Mayberry RD, Krause HM, Bootsma M, Helzer KT, Rydzewski N, Bakhtiar H, Shi Y, Blitzer G, Kyriakopoulos CE, Kosoff D, Wei XX, Floberg J, Sethakorn N, Sharifi M, Harari PM, Huang W, Beltran H, Choueiri TK, Scher HI, Rathkopf DE, Halabi S, Armstrong AJ, Beebe DJ, Yu M, Sundling KE, Taplin ME, Lang JM. A clinical-grade liquid biomarker detects neuroendocrine differentiation in prostate cancer. J Clin Invest 2022; 132:e161858. [PMID: 36317634 PMCID: PMC9621140 DOI: 10.1172/jci161858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/23/2022] [Indexed: 11/07/2022] Open
Abstract
BackgroundNeuroendocrine prostate cancer (NEPC) is an aggressive subtype, the presence of which changes the prognosis and management of metastatic prostate cancer.MethodsWe performed analytical validation of a Circulating Tumor Cell (CTC) multiplex RNA qPCR assay to identify the limit of quantification (LOQ) in cell lines, synthetic cDNA, and patient samples. We next profiled 116 longitudinal samples from a prospectively collected institutional cohort of 17 patients with metastatic prostate cancer (7 NEPC, 10 adenocarcinoma) as well as 265 samples from 139 patients enrolled in 3 adenocarcinoma phase II trials of androgen receptor signaling inhibitors (ARSIs). We assessed a NEPC liquid biomarker via the presence of neuroendocrine markers and the absence of androgen receptor (AR) target genes.ResultsUsing the analytical validation LOQ, liquid biomarker NEPC detection in the longitudinal cohort had a per-sample sensitivity of 51.35% and a specificity of 91.14%. However, when we incorporated the serial information from multiple liquid biopsies per patient, a unique aspect of this study, the per-patient predictions were 100% accurate, with a receiver-operating-curve (ROC) AUC of 1. In the adenocarcinoma ARSI trials, the presence of neuroendocrine markers, even while AR target gene expression was retained, was a strong negative prognostic factor.ConclusionOur analytically validated CTC biomarker can detect NEPC with high diagnostic accuracy when leveraging serial samples that are only feasible using liquid biopsies. Patients with expression of NE genes while retaining AR-target gene expression may indicate the transition to neuroendocrine differentiation, with clinical characteristics consistent with this phenotype.FundingNIH (DP2 OD030734, 1UH2CA260389, R01CA247479, and P30 CA014520), Department of Defense (PC190039 and PC200334), and Prostate Cancer Foundation (Movember Foundation - PCF Challenge Award).
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Affiliation(s)
- Shuang G. Zhao
- Department of Human Oncology and
- Carbone Cancer Center, University of Wisconsin–Madison, Madison, Wisconsin, USA
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA
| | - Jamie M. Sperger
- Carbone Cancer Center, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Department of Medicine, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Jennifer L. Schehr
- Carbone Cancer Center, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Rana R. McKay
- Moores Cancer Center, University of California, San Diego, La Jolla, California, USA
| | - Hamid Emamekhoo
- Carbone Cancer Center, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Department of Medicine, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Anupama Singh
- Carbone Cancer Center, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Zachery D. Schultz
- Carbone Cancer Center, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Rory M. Bade
- Carbone Cancer Center, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Charlotte N. Stahlfeld
- Carbone Cancer Center, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Department of Medicine, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Cole S. Gilsdorf
- Carbone Cancer Center, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Department of Medicine, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Camila I. Hernandez
- Carbone Cancer Center, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Serena K. Wolfe
- Carbone Cancer Center, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | | | - Hannah M. Krause
- Carbone Cancer Center, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Department of Medicine, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Matt Bootsma
- Department of Human Oncology and
- Carbone Cancer Center, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Kyle T. Helzer
- Department of Human Oncology and
- Carbone Cancer Center, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Nicholas Rydzewski
- Department of Human Oncology and
- Carbone Cancer Center, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Hamza Bakhtiar
- Department of Human Oncology and
- Carbone Cancer Center, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Yue Shi
- Department of Human Oncology and
- Carbone Cancer Center, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Grace Blitzer
- Department of Human Oncology and
- Carbone Cancer Center, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Christos E. Kyriakopoulos
- Carbone Cancer Center, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Department of Medicine, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - David Kosoff
- Carbone Cancer Center, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Department of Medicine, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Xiao X. Wei
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - John Floberg
- Department of Human Oncology and
- Carbone Cancer Center, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Nan Sethakorn
- Department of Medicine, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Marina Sharifi
- Department of Medicine, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Paul M. Harari
- Department of Human Oncology and
- Carbone Cancer Center, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Wei Huang
- Carbone Cancer Center, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Department of Pathology and Laboratory Medicine, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Himisha Beltran
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Toni K. Choueiri
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Howard I. Scher
- Genitourinary Oncology Service, Department of Medicine and
- Biomarker Development Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Susan Halabi
- Department of Biostatistics and Bioinformatics and
| | - Andrew J. Armstrong
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - David J. Beebe
- Carbone Cancer Center, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Department of Pathology and Laboratory Medicine, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Department of Biomedical Engineering and
| | - Menggang Yu
- Department of Biostatistics and Medical Informatics, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Kaitlin E. Sundling
- Wisconsin State Lab of Hygiene, Madison, Wisconsin, USA
- Department of Pathology and Laboratory Medicine, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Mary-Ellen Taplin
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Joshua M. Lang
- Carbone Cancer Center, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Department of Medicine, University of Wisconsin–Madison, Madison, Wisconsin, USA
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49
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Hawkey NM, Broderick A, George DJ, Sartor O, Armstrong AJ. The Value of Phenotypic Precision Medicine in Prostate Cancer. Oncologist 2022; 28:93-104. [PMID: 36200788 PMCID: PMC9907055 DOI: 10.1093/oncolo/oyac198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/12/2022] [Indexed: 11/14/2022] Open
Abstract
Prostate cancer is the most common cancer among men and the second leading cause of cancer-related death. For patients who develop metastatic disease, tissue-based and circulating-tumor-based molecular and genomic biomarkers have emerged as a means of improving outcomes through the application of precision medicine. However, the benefit is limited to a minority of patients. An additional approach to further characterize the biology of advanced prostate cancer is through the use of phenotypic precision medicine, or the identification and targeting of phenotypic features of an individual patient's cancer. In this review article, we will discuss the background, potential clinical benefits, and limitations of genomic and phenotypic precision medicine in prostate cancer. We will also highlight how the emergence of image-based phenotypic medicine may lead to greater characterization of advanced prostate cancer disease burden and more individualized treatment approaches in patients.
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Affiliation(s)
- Nathan M Hawkey
- Department of Medicine, Division of Medical Oncology, Duke University School of Medicine, Durham, NC, USA
| | - Amanda Broderick
- Department of Medicine, Division of Medical Oncology, Duke University School of Medicine, Durham, NC, USA
| | - Daniel J George
- Department of Medicine, Division of Medical Oncology, Duke University School of Medicine, Durham, NC, USA,Duke Cancer Institute Center for Prostate and Urologic Cancer, Duke University, Durham, NC, USA
| | - Oliver Sartor
- Tulane Cancer Center, Division of Genitourinary Oncology, New Orleans, LA, USA
| | - Andrew J Armstrong
- Corresponding author: Andrew J. Armstrong, MD, ScM, FACP, Department of Medicine, Surgery, Pharmacology and Cancer Biology, Director of Research, the Duke Cancer Institute Center for Prostate and Urologic Cancers, Divisions of Medical Oncology and Urology, Duke University, DUMC Box 103861, Durham, NC 27710, USA;
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50
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Morris MJ, Mota JM, Lacuna K, Hilden P, Gleave M, Carducci MA, Saad F, Cohn ED, Filipenko J, Heller G, Shore N, Armstrong AJ, Scher HI. Erratum to "Phase 3 Randomized Controlled Trial of Androgen Deprivation Therapy with or Without Docetaxel in High-risk Biochemically Recurrent Prostate Cancer After Surgery (TAX3503)" [Eur Urol Oncol 2021;4:543-52]. Eur Urol Oncol 2022; 5:603. [PMID: 35985981 PMCID: PMC10545163 DOI: 10.1016/j.euo.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Michael J Morris
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
| | - Jose Mauricio Mota
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kristine Lacuna
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Patrick Hilden
- Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Martin Gleave
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Michael A Carducci
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Fred Saad
- Division of Urology, University of Montreal Hospital Center (CHUM), Montreal, QC, Canada
| | - Erica D Cohn
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Julie Filipenko
- Prostate Cancer Clinical Trials Consortium, New York, NY, USA
| | - Glenn Heller
- Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Neal Shore
- Department of Urology, Carolina Urologic Research Center, Myrtle Beach, SC, USA
| | - Andrew J Armstrong
- Divisions of Medical Oncology and Urology, Departments of Medicine and Surgery at the Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University School of Medicine, Durham, NC, USA
| | - Howard I Scher
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA
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