Effect of IL-6 and related mediators on resistance to abiraterone acetate (abi) and enzalutamide (enza) in patients with metastatic castration-resistant prostate cancer (mCRPC).

Authors

Jacob Adashek

Jacob J. Adashek

City of Hope Comprehensive Cancer Center, Duarte, CA

Jacob J. Adashek , Haejung Won , Dayson Moreira , Priyanka Duttagupta , Przemyslaw Twardowski , Jeremy Jones , Marcin Kortylewski , Sumanta K. Pal

Organizations

City of Hope Comprehensive Cancer Center, Duarte, CA, Beckman Research Institute, Duarte, CA, Department of Cancer Immunotherapeutics & Tumor Immunology, City of Hope, Duarte, CA, City of Hope, Duarte, CA

Research Funding

Pharmaceutical/Biotech Company

Background: IL-6 is an upstream regulator of various moieties, including STAT3, that are associated with a poor prognosis in mCRPC. The specific association between these moieties and outcomes with enza and abi are as yet undefined. Methods: Pts receiving abi or enza in the course of routine clinical care were consented for blood collection at weeks 0, 4, 8, and 12 of therapy, and at the time of progression (based on PCWG3 criteria). PBMCs were isolated within 4 hours of blood collection and plasma samples were assessed for 30 soluble immune mediators using Luminex analysis. Flow cytometric analysis was used for characterization of CD3, CD4, CD8 and PD-1. CellSearch was used for CTC enumeration. Results: Of 36 patients consented, 21 received abi and 15 received enza. Median age in the cohort was 71 (range, 54-84). Median PSA was 21.9 ng/dL (range, 0-918.3) and mean CTC count was 158 (range, 0-2126). Median duration of therapy (DOT) with abi or enza was 10.5 mos (range, 1-53); pts were divided into two groups around median DOT. Median DOT in Group A and B were 4 mos (range, 1-10) and 49 mos (range, 11-53), respectively. Patients in Group A had higher levels of pre-treatment levels of IL-6, IL-10, GM-CSF, MIG and FGF, and higher expression of PD1 and FoxP3 on CD4+ T cells (P < 0.05 for each). In an exploratory analysis, patients with > 5 CTCs/7.5 mL of blood at baseline had higher levels of IL-6, although this was not statistically significant (P = 0.08). Conclusions: Elevated levels of IL-6 and several other cytokines are seen in patients with relative resistance to abi/enza for mCRPC. Surface expression of PD-1 and FoxP3 on CD4+ T-cells is also higher in the setting of resistance. The dual combination of elevated pro-inflammatory cytokines along with elevated immunosuppressive signals supports ongoing trials assessing checkpoint inhibition with abi/enza, as well as efforts by the current investigators to develop therapies antagonizing STAT3 (Moreira D et al CCR 2018).

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Abstract Details

Meeting

2019 Genitourinary Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session B: Prostate Cancer; Urothelial Carcinoma; Penile, Urethral, Testicular, and Adrenal Cancers

Track

Urothelial Carcinoma,Prostate Cancer,Penile, Urethral, Testicular, and Adrenal Cancers

Sub Track

Prostate Cancer - Advanced Disease

Citation

J Clin Oncol 37, 2019 (suppl 7S; abstr 296)

DOI

10.1200/JCO.2019.37.7_suppl.296

Abstract #

296

Poster Bd #

D4

Abstract Disclosures