Clinical testing of transcriptome-wide expression profiles in high-risk localized and metastatic prostate cancer starting androgen deprivation therapy: an ancillary study of the STAMPEDE abiraterone Phase 3 trial

Metastatic and high-risk localized prostate cancer respond to hormone therapy but outcomes vary. Following a pre-specified statistical plan, we used Cox models adjusted for clinical variables to test associations with survival of multi-gene expression-based classifiers from 781 patients randomized to androgen deprivation with or without abiraterone in the STAMPEDE trial. Decipher score was strongly prognostic (p<2×10-5) and identified clinically-relevant differences in absolute benefit, especially for localized cancers. In metastatic disease, classifiers of proliferation, PTEN or TP53 loss and treatment-persistent cells were prognostic. In localized disease, androgen receptor activity was protective whilst interferon signaling (that strongly associated with tumor lymphocyte infiltration) was detrimental. Post-Operative Radiation-Therapy Outcomes Score was prognostic in localized but not metastatic disease (interaction p=0.0001) suggesting the impact of tumor biology on clinical outcome is context-dependent on metastatic state. Transcriptome-wide testing has clinical utility for advanced prostate cancer and identified worse outcomes for localized cancers with tumor-promoting inflammation.

Accumulation of copy number alterations and clinical progression across advanced prostate cancer

BACKGROUND

Genomic copy number alterations commonly occur in prostate cancer and are one measure of genomic instability. The clinical implication of copy number change in advanced prostate cancer, which defines a wide spectrum of disease from high-risk localised to metastatic, is unknown.

METHODS

We performed copy number profiling on 688 tumour regions from 300 patients, who presented with advanced prostate cancer prior to the start of long-term androgen deprivation therapy (ADT), in the control arm of the prospective randomised STAMPEDE trial. Patients were categorised into metastatic states as follows; high-risk non-metastatic with or without local lymph node involvement, or metastatic low/high volume. We followed up patients for a median of 7 years. Univariable and multivariable Cox survival models were fitted to estimate the association between the burden of copy number alteration as a continuous variable and the hazard of death or disease progression.

RESULTS

The burden of copy number alterations positively associated with radiologically evident distant metastases at diagnosis (P=0.00006) and showed a non-linear relationship with clinical outcome on univariable and multivariable analysis, characterised by a sharp increase in the relative risk of progression (P=0.003) and death (P=0.045) for each unit increase, stabilising into more modest increases with higher copy number burdens. This association between copy number burden and outcome was similar in each metastatic state. Copy number loss occurred significantly more frequently than gain at the lowest copy number burden quartile (q=4.1 × 10-6). Loss of segments in chromosome 5q21-22 and gains at 8q21-24, respectively including CHD1 and cMYC occurred more frequently in cases with higher copy number alteration (for either region: Kolmogorov-Smirnov distance, 0.5; adjusted P<0.0001). Copy number alterations showed variability across tumour regions in the same prostate. This variance associated with increased risk of distant metastases (Kruskal-Wallis test P=0.037).

CONCLUSIONS

Copy number alteration in advanced prostate cancer associates with increased risk of metastases at diagnosis. Accumulation of a limited number of copy number alterations associates with most of the increased risk of disease progression and death. The increased likelihood of involvement of specific segments in high copy number alteration burden cancers may suggest an order underlying the accumulation of copy number changes.

TRIAL REGISTRATION

ClinicalTrials.gov NCT00268476 , registered on December 22, 2005. EudraCT  2004-000193-31 , registered on October 4, 2004.

Proliferation index and survival in men with prostate cancer starting long-term androgen deprivation therapy in the STAMPEDE clinical trial

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Background: Treatment intensification with docetaxel or abiraterone improved survival for advanced prostate cancer starting androgen deprivation therapy (ADT) in the Systemic Therapy in Advancing or Metastatic Prostate Cancer: Evaluation of Drug Efficacy (STAMPEDE, NCT00268476) trial. However, survival and time-to-progression is highly variable on ADT, introducing the risk of unnecessary toxicity from additional treatments for some patients. Here we test the prognostic association of proliferation index using Ki67 scores in the control arm of the STAMPEDE population of high-risk localised (M0) and metastatic (M1) prostate cancer. Methods: Pre-ADT diagnostic needle biopsies were obtained from 517 men randomized in STAMPEDE arm A between 2006 and 2015. These were assessed for proliferation using an analytically optimised Ki67 immunohistochemistry assay. Ki67 was tested for associations with baseline clinico-pathological variables (Grade group, pre-ADT serum PSA and imaging metastatic burden) in univariable linear-regression models, and for associations with survival outcomes in multivariable Cox-regression models adjusted for these and additional confounding variables. Primary outcome measure was overall survival, secondary outcomes were prostate cancer-specific, failure-free, progression-free and metastatic progression-free survival. Results: Ki67 was available for 475 patients who received ADT only for at least 2 years ± radiotherapy. Of 202 M0, 74 were node positive. Of 273 M1, 116, 127 and 30 were respectively low, high and unknown radiological M1 volume. Ki67 score associated with higher Gleason (p=7.15x10-11) and presence of extra-pelvic metastases (p=1.41x10-8). Increasing Ki67 scores showed a strong linear association with poorer overall survival, with an estimated 2% increase in the hazard of death per percentage increase in the score (adjusted HR=1.02, 95% CI 1.01-1.02; p=1.04x10-5). There was also strong evidence that Ki67 associated positively with all secondary outcomes, including prostate cancer-specific survival (adjusted p=5.50x10-6) and metastatic progression-free survival (adjusted p=3.50x10-9). Conclusions: Ki67 immuno-score is strongly prognostic in clinically advanced prostate cancer independent of Gleason score and the other clinicopathological variables tested in this study. Ki67 is a clinically scalable assay that could improve selection for treatment intensification and provide a tool for screening patients most likely to benefit from further molecular investigation.

Clinical evaluation of a sub-lingual vaccine for prevention of exacerbations in COPD

Background: Lower airway bacterial infection is one of the major cause for exacerbation inCOPD. Multicomponent vaccines derived from the various causative pathogens are shownto prevent the exacerbations.Aims and Objectives: The present study was carried out toevaluate the effi cacy of sublingual vaccine (Ismigen) in preventing the exacerbations inCOPD and to observe its tolerability.Materials and Methods: Twenty four COPD patientsmeeting the eligibility criteria were enrolled in the study. Ismigen was administered once aday sublingually for ten days a month for three consecutive months. They were observed over one year for exacerbations, hospitalisations, respiratory symptoms, lung function tests and adverse reactions. The mean scores of the parameters in the previous year were compared with that of the year following treatment. Students t test and Chi- square test were used for analysis. Results: The mean number of exacerbations reduced from 6.79±3.51 to 2.67±1.90 (p<0.001) and the mean number of hospitalisations from 2.29±1.85 to 0.67±0.87 (p<0.001). There was no significant change in the respiratory symptom score and lung function test. Mild non-serious adverse event was reported by one patient.Conclusion: The results indicated that Ismigen could be an effective and well-tolerated add on therapy in COPD to reduce the frequency and severity of exacerbations.DOI: http://dx.doi.org/10.3126/ajms.v6i4.11634 Asian Journal of Medical Sciences Vol.6(4) 2015 51-54

The Dependence of Electron Transfer Efficiency on the Conformational Order in Organic Monolayers

The electron transfer through an organized organic monolayer of alkyl chains adsorbed on a silicon wafer has been studied. The silicon was used as an electrode in a three-electrode electrochemical cell, and the current versus voltage response was measured. The results show that when the chains in the monolayer are in the "all trans" configuration, the charge transfer efficiency is higher than when the chains have a "gauche" configuration. A mechanism rationalizing all the observations is suggested.

Comparative efficacy of oral sustained released bronchodilator in stable asthmatics

Double blind randomized trial of oral conventional and sustained release bronchodilators was undertaken to observe comparative efficacy in 30 patients older than 15 years. All cases selected were stable asthmatics at least for last 2 years having FEV1 improvement > or = 20%. Basal Pulmonary functions like FEV1, FVC and PEFR were recorded before and after drug administration at 1/2, 1, 2, 3, 4, 6, 8, 10, 12 and 24 hours. Four drug regimens were given as a single dose in the morning on randomized crossover manner on 1st, 4th, 7th and 10th days, sustained release theophylline 300 mg+salbutamol 4 mg (Drug I), salbutamol 4 mg + theophylline 300 mg (Drug II), salbutamol sustained released (asthalin SA) 8 mg (Drug III), salbutamol sustained released (ventorlin CR) 8 mg (Drug IV). Mean FEV1 changes observed at 0, 6 and 12 hours for all the drugs were compared which showed no statistical significance (t = 2.3876). Therefore, we conclude that using single dose fixed combination of oral salbutamol and aminophylline either in a plain or slow released form have no additive bronchodilator effect as compared to salbutamol alone in stable asthmatics.