Association of molecular subtypes with pathologic response in a phase II study of co-expression extrapolation (COXEN) with neoadjuvant chemotherapy (NAC) for localized, muscle-invasive bladder cancer (SWOG S1314; NCT02177695).

Authors

null

Seth P. Lerner

Baylor College of Medicine, Houston, TX

Seth P. Lerner , David James McConkey , Catherine Tangen , Joshua J Meeks , Thomas W. Flaig , Xing Hua , Siamak Daneshmand , Ajjai Shivaram Alva , M. Scott Lucia , Dan Theodorescu , Amir Goldkorn , Matthew I. Milowsky , Woonyoung Choi , Richard Carlton Bangs , Daniel Gustafson , Ian Murchie Thompson Jr.

Organizations

Baylor College of Medicine, Houston, TX, Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD, SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA, Northwestern University, Chicago, IL, University of Colorado Anschutz Medical Campus, Aurora, CO, Fred Hutchinson Cancer Research Center, Seattle, WA, USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles, CA, University of Michigan Rogel Cancer Center, Ann Arbor, MI, Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai, Los Angeles, CA, Division of Medical Oncology, Department of Medicine, Keck School of Medicine and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, University of North Carolina Department of Medicine, Division of Hematology/Oncology, Chapel Hill, NC, Bladder Cancer Advocacy Network, Pittsford, NY, Colorado State University, Fort Collins, CO, Christus Santa Rosa Hospital-Medical Center, San Antonio, TX

Research Funding

U.S. National Institutes of Health
U.S. National Institutes of Health

Background: Cisplatin-based NAC is recommended for patients with MIBC prior to radical cystectomy (RC) but the majority will not have a pathologic response. To identify responders the COXEN gene expression model with chemotherapy-specific scores (for DD-MVAC and GC) was developed and in a prospective rPII clinical trial (SWOG S1314) the GC score was associated with path downstaging in the pooled arms. We investigated RNA based molecular subtypes as additional predictive biomarkers for response to NAC in patients treated in S1314. Methods: Eligibility required cT2-T4a N0 M0, predominant urothelial, > 5 mm tumor, cisplatin eligible, and plan for RC and PLND. 237 patients were randomized between 4 cycles of ddMVAC and GC. Based on Affymetrix transcriptomic data used to assign COXEN scores, we determined subtypes using 3 classifiers: TCGA (k=5), Consensus (k=6), and MD Anderson (MDA; k=3). Primary objective was to assess subtype association with pathologic response to NAC in the pooled arms and to determine any association with COXEN. TCGA and Consensus classifiers were collapsed into 3 groups for ROC analyses. We tested whether each classifier contributed additional predictive power when added to a model based on pre-defined stratification factors (PS 0 vs. 1; T2 vs. T3, T4a). Results: 161 patients had adequate tissue and gene expression results, received at least 3 of 4 cycles of NAC and had pT-N response based on RC. Covariates were 78% PS=0, 89% T2, 84% male, median age 65, 51% randomized to ddMVAC, 49% GC with 33% pT0 and 52% downstaging. Although the TCGA 3 group classifier (Basal-Squamous (BS)/Neuronal, Luminal, Luminal infiltrated) and GC Coxen score yielded the largest AUCs (0.607, 0.610) for pT0 response, neither reached statistical significance (p=0.20, p=0.22). For downstaging (<pT2), the 3 category Consensus classifier (BS/NE-like, Luminal, Stroma-rich) significantly increased the AUC from 0.568 (strat factors alone) to 0.620 (p=0.044). The MDA classifier AUC was 0.640 and the GC Coxen score AUC was 0.626, but neither were significant (p=0.076, p=0.14. The MVAC Coxen score did not improve the AUC beyond the stratification factors. Conclusions: The Consensus classifier, which is based in part on the TCGA and MDA classifiers, modestly improved prediction for pathologic downstaging when added to clinical stage and PS. With additional followup, we will assess the association of COXEN scores and subtypes with overall survival. Clinical trial information: NCT02177695.

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Abstract Details

Meeting

2020 ASCO Virtual Scientific Program

Session Type

Poster Session

Session Title

Genitourinary Cancer—Kidney and Bladder

Track

Genitourinary Cancer—Kidney and Bladder

Sub Track

Bladder Cancer

Clinical Trial Registration Number

NCT02177695

Citation

J Clin Oncol 38: 2020 (suppl; abstr 5028)

DOI

10.1200/JCO.2020.38.15_suppl.5028

Abstract #

5028

Poster Bd #

97

Abstract Disclosures