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Menssouri N, Poiraudeau L, Helissey C, Bigot L, Sabio J, Ibrahim T, Pobel C, Nicotra C, Ngo-Camus M, Lacroix L, Rouleau E, Tselikas L, Chauchereau A, Blanc-Durand F, Bernard-Tessier A, Patrikidou A, Naoun N, Flippot R, Colomba E, Fuerea A, Albiges L, Lavaud P, van de Wiel P, den Biezen E, Wesseling-Rozendaal Y, Ponce S, Michiels S, Massard C, Gautheret D, Barlesi F, André F, Besse B, Scoazec JY, Friboulet L, Fizazi K, Loriot Y. Genomic Profiling of Metastatic Castration-Resistant Prostate Cancer Samples Resistant to Androgen Receptor Pathway Inhibitors. Clin Cancer Res 2023; 29:4504-4517. [PMID: 37364000 DOI: 10.1158/1078-0432.ccr-22-3736] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/19/2023] [Accepted: 06/20/2023] [Indexed: 06/28/2023]
Abstract
PURPOSE The androgen receptor axis inhibitors (ARPI; e.g., enzalutamide, abiraterone acetate) are administered in daily practice for men with metastatic castration-resistant prostate cancer (mCRPC). However, not all patients respond, and mechanisms of both primary and acquired resistance remain largely unknown. EXPERIMENTAL DESIGN In the prospective trial MATCH-R (NCT02517892), 59 patients with mCRPC underwent whole-exome sequencing (WES) and/or RNA sequencing (RNA-seq) of samples collected before starting ARPI. Also, 18 patients with mCRPC underwent biopsy at time of resistance. The objectives were to identify genomic alterations associated with resistance to ARPIs as well as to describe clonal evolution. Associations of genomic and transcriptomic alterations with primary resistance were determined using Wilcoxon and Fisher exact tests. RESULTS WES analysis indicated that no single-gene genomic alterations were strongly associated with primary resistance. RNA-seq analysis showed that androgen receptor (AR) gene alterations and expression levels were similar between responders and nonresponders. RNA-based pathway analysis found that patients with primary resistance had a higher Hedgehog pathway score, a lower AR pathway score and a lower NOTCH pathway score than patients with a response. Subclonal evolution and acquisition of new alterations in AR-related genes or neuroendocrine differentiation are associated with acquired resistance. ARPIs do not induce significant changes in the tumor transcriptome of most patients; however, programs associated with cell proliferation are enriched in resistant samples. CONCLUSIONS Low AR activity, activation of stemness programs, and Hedgehog pathway were associated with primary ARPIs' resistance, whereas most acquired resistance was associated with subclonal evolution, AR-related events, and neuroendocrine differentiation. See related commentary by Slovin, p. 4323.
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Affiliation(s)
- Naoual Menssouri
- Inserm U981, Molecular Predictors and New Targets in Oncology, Gustave Roussy Cancer Campus, Paris-Saclay University, Villejuif, France
| | - Loïc Poiraudeau
- Inserm U981, Molecular Predictors and New Targets in Oncology, Gustave Roussy Cancer Campus, Paris-Saclay University, Villejuif, France
| | | | - Ludovic Bigot
- Inserm U981, Molecular Predictors and New Targets in Oncology, Gustave Roussy Cancer Campus, Paris-Saclay University, Villejuif, France
| | - Jonathan Sabio
- Inserm U981, Molecular Predictors and New Targets in Oncology, Gustave Roussy Cancer Campus, Paris-Saclay University, Villejuif, France
| | - Tony Ibrahim
- Inserm U981, Molecular Predictors and New Targets in Oncology, Gustave Roussy Cancer Campus, Paris-Saclay University, Villejuif, France
| | - Cédric Pobel
- Inserm U981, Molecular Predictors and New Targets in Oncology, Gustave Roussy Cancer Campus, Paris-Saclay University, Villejuif, France
| | - Claudio Nicotra
- Drug Development Department (DITEP), Gustave Roussy Cancer Campus, Villejuif, France
| | - Maud Ngo-Camus
- Drug Development Department (DITEP), Gustave Roussy Cancer Campus, Villejuif, France
| | - Ludovic Lacroix
- Experimental and Translational Pathology Platform (PETRA), Genomic Platform-Molecular Biopathology Unit (BMO) and Biological Resource Center, AMMICA, INSERM US23/CNRS UMS3655, Gustave Roussy Cancer Campus, Villejuif, France
- Department of Medical Biology and Pathology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Etienne Rouleau
- Experimental and Translational Pathology Platform (PETRA), Genomic Platform-Molecular Biopathology Unit (BMO) and Biological Resource Center, AMMICA, INSERM US23/CNRS UMS3655, Gustave Roussy Cancer Campus, Villejuif, France
- Department of Medical Biology and Pathology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Lambros Tselikas
- Department of Interventional Radiology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Anne Chauchereau
- Inserm U981, Molecular Predictors and New Targets in Oncology, Gustave Roussy Cancer Campus, Paris-Saclay University, Villejuif, France
| | - Félix Blanc-Durand
- Department of Medical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | | | - Anna Patrikidou
- Department of Medical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Natacha Naoun
- Department of Medical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Ronan Flippot
- Department of Medical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Emeline Colomba
- Department of Medical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Alina Fuerea
- Department of Medical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Laurence Albiges
- Department of Medical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Pernelle Lavaud
- Department of Medical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | | | | | | | - Santiago Ponce
- Drug Development Department (DITEP), Gustave Roussy Cancer Campus, Villejuif, France
| | - Stefan Michiels
- Oncostat U1018, Inserm, University of Paris-Saclay, Labelled Ligue Contre le Cancer, Villejuif, France
| | - Christophe Massard
- Drug Development Department (DITEP), Gustave Roussy Cancer Campus, Villejuif, France
| | - Daniel Gautheret
- Department of Biostatistics and Epidemiology, Gustave Roussy, University of Paris-Saclay, Villejuif, France
- PRISM Center for Personalized Medicine, Gustave Roussy Cancer Campus, Villejuif, France
| | - Fabrice Barlesi
- Inserm U981, Molecular Predictors and New Targets in Oncology, Gustave Roussy Cancer Campus, Paris-Saclay University, Villejuif, France
| | - Fabrice André
- Inserm U981, Molecular Predictors and New Targets in Oncology, Gustave Roussy Cancer Campus, Paris-Saclay University, Villejuif, France
- Department of Biostatistics and Epidemiology, Gustave Roussy, University of Paris-Saclay, Villejuif, France
- PRISM Center for Personalized Medicine, Gustave Roussy Cancer Campus, Villejuif, France
| | - Benjamin Besse
- Inserm U981, Molecular Predictors and New Targets in Oncology, Gustave Roussy Cancer Campus, Paris-Saclay University, Villejuif, France
- Department of Medical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
- Department of Biostatistics and Epidemiology, Gustave Roussy, University of Paris-Saclay, Villejuif, France
| | - Jean-Yves Scoazec
- Inserm U981, Molecular Predictors and New Targets in Oncology, Gustave Roussy Cancer Campus, Paris-Saclay University, Villejuif, France
- Experimental and Translational Pathology Platform (PETRA), Genomic Platform-Molecular Biopathology Unit (BMO) and Biological Resource Center, AMMICA, INSERM US23/CNRS UMS3655, Gustave Roussy Cancer Campus, Villejuif, France
- Department of Medical Biology and Pathology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Luc Friboulet
- Inserm U981, Molecular Predictors and New Targets in Oncology, Gustave Roussy Cancer Campus, Paris-Saclay University, Villejuif, France
| | - Karim Fizazi
- Inserm U981, Molecular Predictors and New Targets in Oncology, Gustave Roussy Cancer Campus, Paris-Saclay University, Villejuif, France
- Department of Medical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Yohann Loriot
- Inserm U981, Molecular Predictors and New Targets in Oncology, Gustave Roussy Cancer Campus, Paris-Saclay University, Villejuif, France
- Drug Development Department (DITEP), Gustave Roussy Cancer Campus, Villejuif, France
- Department of Medical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
- Department of Biostatistics and Epidemiology, Gustave Roussy, University of Paris-Saclay, Villejuif, France
- PRISM Center for Personalized Medicine, Gustave Roussy Cancer Campus, Villejuif, France
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