Use of plasma androgen receptor (AR) testing to optimize docetaxel chemotherapy in castration-resistant prostate cancer (CRPC): A multicenter biomarker study.

Authors

null

Vincenza Conteduca

IRCCS-IRST (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori), Meldola, Italy

Vincenza Conteduca , Elena Castro , Daniel Wetterskog , Emanuela Scarpi , Nuria Romero-Laorden , Giorgia Gurioli , Anuradha Jayaram , Cristian Lolli , Giuseppe Schepisi , Anna Wingate , Chiara Casadei , Rebeca Lozano , Nicole Brighi , Isabel Aragon , Mercedes Marín-Aguilera , Enrique González-Billalabeitia , Begona Mellado , David Olmos , Gerhardt Attard , Ugo De Giorgi

Organizations

IRCCS-IRST (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori), Meldola, Italy, Hospitales Virgen de la Victoria y Regional de Málaga, Instituto de Investigación Biomédica de Málaga, Málaga, Spain, UCL Cancer Institute, London, United Kingdom, Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy, Spanish National Cancer Research Center, Madrid, Spain, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy, University College London Cancer Institute, London, United Kingdom, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy, University College London, London, United Kingdom, Spanish National Cancer Research Centre, Prostate Cancer Clinical Research Unit, Madrid, Spain, Genitourinary Cancer Traslational Research Unit, Institute of Biomedical Research in Málaga (IBIMA), Málaga, Spain, Fundació Clínic per a la Recerca Biomèdica, Barcelona, Spain, Department of Hematology and Medical Oncology, Hospital Universitario Morales Meseguer, Murcia, Spain, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain, Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Center, Madrid, Spain, Institute of Cancer Research and The Royal Marsden Hospital, Sutton, United Kingdom, Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy

Research Funding

No funding received
None

Background: Plasma AR status has been identified as a potential biomarker of response in CRPC patients receiving docetaxel or the AR-targeted therapies abiraterone or enzalutamide. However, the relevance of plasma AR in the overall management of CRPC patients (pts) receiving docetaxel at different dose due to the toxicity profiles and physician-patient preferences is unknown. Methods: This was a multi-institution study of associations between baseline plasma AR-copy-number status assessed by droplet digital PCR and outcome in 325 CRPC pts. Between September 2011 and July 2019 pts started treatment with docetaxel administered at standard regimen 75mg/m2 every three weeks or adapted regimen (75-80% of standard recommended dose or 30mg/m2 weekly administration) at the discretion of the treating physician. Patients were assigned randomly into 2 sets with a ratio 2:1 to either training (n=217) and internal validation (n=108) cohorts. Results: In our study, adapted regimen of docetaxel was administered in 68 (31.3%) and 35 (32.4%) of training and validation cohorts, respectively. Based on plasma AR status, 67 (30.9%) and 39 (36.1%) validation and training set pts were classified as AR gain, respectively. In men treated with standard docetaxel regimen, no difference in progression-free/overall survival (PFS/OS) was seen between plasma AR normal and gain in both cohorts. In patients treated with adapted docetaxel regimen, we observed a significantly shorter median PFS (3.9 vs. 6.4 months, HR 4.77, 95%CI 1.48-3.80, p=0.0003) and median OS (11.2 vs. 20.4 months, HR 2.87, 95%CI 1.73-2.13, p=0.0008) in the training cohort. This finding was confirmed in the validation cohort (median PFS: 4.8 vs. 7.4 months, HR 2.54, 95%CI 1.40-4.58, p=0.005, and median OS: 11.8 vs. 26.4 months, HR 5.00, 95%CI 2.59-9.65, p<0.0001). In addition, AR-gained patients were less likely than AR normal to have a PSA decline when receiving an adapted regimen in both cohorts (p=0.010 e p=0.003, respectively). Conclusions: This study suggests that plasma AR may improve clinical decision making in choosing not only between AR-directed therapies and taxanes, but also between adapted and standard regimen of docetaxel in first- and subsequent-therapy lines, providing promising clinical implications to select the proper timing and dose of docetaxel. Prospective trials to validate these findings are warranted.

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Abstract Details

Meeting

2020 ASCO Virtual Scientific Program

Session Type

Poster Session

Session Title

Genitourinary Cancer—Prostate, Testicular, and Penile

Track

Genitourinary Cancer—Prostate, Testicular, and Penile

Sub Track

Prostate Cancer - Advanced Disease

Citation

J Clin Oncol 38: 2020 (suppl; abstr 5546)

DOI

10.1200/JCO.2020.38.15_suppl.5546

Abstract #

5546

Poster Bd #

127

Abstract Disclosures