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Moses M, Niu A, Lilly MB, Hahn AW, Nussenzveig R, Ledet E, Manogue C, Cotogno P, Lewis B, Layton J, Agarwal N, Sartor O, Barata PC. Circulating-tumor DNA as predictor of enzalutamide response post-abiraterone treatment in metastatic castration-resistant prostate cancer. Cancer Treat Res Commun 2020; 24:100193. [PMID: 32702615 DOI: 10.1016/j.ctarc.2020.100193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/24/2020] [Revised: 06/19/2020] [Accepted: 07/11/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The crossover from abiraterone acetate (AA) to enzalutamide (ENZA) is a frequent approach in clinical practice. Our aim was to explore the role of genomic alterations as putative biomarkers of response to sequential AA followed by ENZA in mCRPC and their association with clinical outcomes. PATIENTS AND METHODS This was a multi-center, retrospective analysis of mCRPC patients with circulating-tumor DNA (ctDNA) post-AA and prior to ENZA treatment. Objectives of this analysis were to assess PSA response, time to PSA progression (TTP) and overall survival (OS) in mCRPC patients treated with ENZA following progression on AA with respect to genomic aberrations detected by ctDNA. RESULTS A total of 28 patients with mCRPC were identified. Median time between AA and ENZA was 3.1 months and median initial PSA prior to ENZA was 35.0 ng/mL. Nine patients (32.1%) achieved PSA responses to ENZA. Most patients (79.0%) achieved confirmed PSA progression with median TTP of 1.6 months (95% CI, 0.7-2.4). Somatic alterations in AR genes were detected in 36.0% of patients with other common alterations detected including 39.0% TP53, 11.0% DNA repair, and 11.0% PTEN. A lack of AR alterations was associated with better PSA response to ENZA (p = 0.04). CONCLUSION While lack of AR alterations in ctDNA was associated with more favorable outcomes, the present dataset is insufficient to recommend the use of ctDNA to impact clinical decision-making in this setting. Further understanding of the implications of the genomic phenotype in ctDNA of castration-resistant tumors and the potential therapeutic implications is required.
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Affiliation(s)
- Marcus Moses
- Department of Internal Medicine, Section of Hematology and Medical Oncology, Tulane University School of Medicine, 1430 Tulane Ave., New Orleans 70112, LA, USA
| | - Alex Niu
- Department of Internal Medicine, Section of Hematology and Medical Oncology, Tulane University School of Medicine, 1430 Tulane Ave., New Orleans 70112, LA, USA
| | | | - Andrew W Hahn
- MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | | | - Elisa Ledet
- Department of Internal Medicine, Section of Hematology and Medical Oncology, Tulane University School of Medicine, 1430 Tulane Ave., New Orleans 70112, LA, USA
| | - Charlotte Manogue
- Department of Internal Medicine, Section of Hematology and Medical Oncology, Tulane University School of Medicine, 1430 Tulane Ave., New Orleans 70112, LA, USA
| | - Patrick Cotogno
- Department of Internal Medicine, Section of Hematology and Medical Oncology, Tulane University School of Medicine, 1430 Tulane Ave., New Orleans 70112, LA, USA
| | - Brian Lewis
- Department of Internal Medicine, Section of Hematology and Medical Oncology, Tulane University School of Medicine, 1430 Tulane Ave., New Orleans 70112, LA, USA
| | - Jodi Layton
- Department of Internal Medicine, Section of Hematology and Medical Oncology, Tulane University School of Medicine, 1430 Tulane Ave., New Orleans 70112, LA, USA
| | - Neeraj Agarwal
- Huntsman Cancer Institute, University of Utah, Salt Lake, UT, USA
| | - Oliver Sartor
- Department of Internal Medicine, Section of Hematology and Medical Oncology, Tulane University School of Medicine, 1430 Tulane Ave., New Orleans 70112, LA, USA
| | - Pedro C Barata
- Department of Internal Medicine, Section of Hematology and Medical Oncology, Tulane University School of Medicine, 1430 Tulane Ave., New Orleans 70112, LA, USA.
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