Validation of the decipher genomic classifier (GC) in SAKK 09/10: A phase III randomized trial of dose-escalated salvage radiotherapy (SRT) after radical prostatectomy (RP).

Authors

null

Alan Dal Pra

Miller School of Medicine, University of Miami, Miami, FL

Alan Dal Pra , Pirus Ghadjar , Stefanie Hayoz , Daniel Eidelberg Spratt , Vinnie YT Liu , Tamara Todorovic , Elai Davicioni , Huei-Chung Huang , Philipp Gut , Ludwig Plasswilm , Tobias Hölscher , Bülent Polat , Guido Hildebrandt , Arndt-Christian Mueller , George N. Thalmann , Daniel Rudolf Zwahlen , Daniel M. Aebersold

Organizations

Miller School of Medicine, University of Miami, Miami, FL, Charité Universitätsmedizin Berlin, Berlin, Germany, Swiss Group for Clinical Cancer Research, Bern, Switzerland, University of Michigan Department of Radiation Oncology, Ann Arbor, MI, Decipher Biosciences, San Diego, CA, Decipher Biosciences, Inc., San Diego, CA, Decipher Biosciences, Inc, San Diego, CA, Decipher BioSciences, San Diego, CA, Hirslanden Hospital Group, Zürich, Switzerland, Kantonsspital St Gallen, St. Gallen, Switzerland, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany, Radiation Oncology, University Hospital Würzburg, Wurzburg, Germany, University of Rostock, Rostock, Germany, Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany, University of Bern, Bern, Switzerland, Kantonsspital Graubuenden, Chur, Switzerland, Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

Research Funding

Pharmaceutical/Biotech Company
Decipher Biosciences

Background: GC has been shown to independently prognosticate outcomes in prostate cancer. Herein, we validate the GC in a European randomized phase III trial of dose escalated SRT after RP. Methods: SAKK 09/10 (NCT01272050) randomized 350 patients with biochemical recurrence after RP to 64Gy vs 70Gy. No patients received androgen deprivation therapy (ADT) or pelvic nodal radiotherapy. A pre-specified statistical plan was developed to assess the impact of the GC on clinical outcomes. RP samples were centrally reviewed for the highest-grade tumor and those passing quality control (QC) were run on a clinical-grade whole-transcriptome assay to obtain the GC score (0 to 1; < 0.45, 0.45-0.6, > 0.6 for low-, intermediate-, and high, respectively). The primary aim of this study was to validate the GC for the prediction of freedom from biochemical progression (FFBP) using Cox multivariable analysis (MVA) adjusting for age, T-category, Gleason score, persistent PSA after RP, PSA at randomization, and randomization arm. The secondary aims were to evaluate the association of GC with clinical progression-free survival (CPFS) and use of salvage ADT. Results: Of 233 patients with tissue available, 226 passed QC and were included for analysis. The final GC cohort was a representative sample of the overall cohort, with a median follow-up of 6.3 years (IQR 6.0-7.2). GC score (continuous per 0.1 unit, score 0-1) was independently associated with FFBP (HR 1.14 [95% CI 1.03-1.25], p = 0.009). Higher GC scores were independently associated with CPFS, use of salvage ADT, and rapid biochemical failure ( < 18 months after SRT). High- vs. low/intermediate-GC showed a HR of 2.22 ([95% CI 1.37-3.58], p = 0.001) for FFBP, 2.29 ([95% CI 1.32-3.98], p = 0.003) for CPFS, and 2.99 ([95% CI 1.50-5.95], p = 0.002) for use of salvage ADT. Patients with high-GC had 5-year FFBP of 45% [95% CI 32-59] vs 71% [95% CI 64-78] in low-intermediate GC. Similar estimates for GC risk groups were observed in the 64Gy vs 70Gy in GC high (5-year FFBP of 51% [95% CI 32-70] vs 39% [95% CI 20-59]) and in low-intermediate GC (75% [95% CI 65-84] vs 69% [95% CI 59-78]). Conclusions: This study represents the first contemporary randomized controlled trial in patients with recurrent prostate cancer treated with early SRT without ADT that has validated the prognostic utility of the GC. Independent of standard clinicopathologic variables and radiotherapy dose, patients with a high-GC were more than twice as likely than a lower GC score to experience biochemical and clinical progression and receive salvage ADT. This data confirms the clinical value of Decipher GC for tailoring treatment in the postoperative salvage setting.

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Abstract Details

Meeting

2021 ASCO Annual Meeting

Session Type

Poster Discussion Session

Session Title

Genitourinary Cancer—Prostate, Testicular, and Penile

Track

Genitourinary Cancer—Prostate, Testicular, and Penile

Sub Track

Prostate Cancer–Local-Regional Disease

Citation

J Clin Oncol 39, 2021 (suppl 15; abstr 5010)

DOI

10.1200/JCO.2021.39.15_suppl.5010

Abstract #

5010

Abstract Disclosures