Androgen receptor (AR) mutations in men with metastatic castration-resistant prostate cancer (mCRPC): Incidence and natural history.

Authors

null

Alice Bernard-Tessier

Gustave Roussy, Villejuif, France

Alice Bernard-Tessier , Guillaume Mulier , Paula Nay , Capucine Baldini , Laurence Albiges , Emeline Colomba , Ronan Flippot , Pernelle Lavaud , Natacha Naoun , Anna Patrikidou , Yohann Loriot , Christophe Massard , Stéphanie Foulon , Karim Fizazi

Organizations

Gustave Roussy, Villejuif, France, Medical Oncology, Gustave Roussy, Université Paris Saclay, Paris, France, Gustave Roussy Cancer Campus, Villejuif, France, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France, Gustave Roussy Cancer Centre, Villejuif, France, Gustave Roussy – Department of Therapeutic Innovation and Early Trials (DITEP), Paris, France, Gustave Roussy Institute, Villejuif, France

Research Funding

No funding received
None.

Background: AR ligand binding domain (LBD) activating somatic point mutation is a known mechanism of resistance to androgen-receptor signaling inhibitor (ARSI) treatment in mCRPC, leading to a persistent addiction to steroid hormones. Two early phase trials investigating CYP11A1 inhibitors - CYPIDES (ODM208, NCT03436485) and STESIDES (ODM209, NCT03878823) - recruited mCRPC patients with and without pre-specified AR LBD mutation. In CYPIDES Part 1, AR LBD mutations (ARm) strongly predicted for PSA decline with ODM-208 (Fizazi, ASCO GU 2021). Here, we evaluated clinical and genomic data associated with ARm in patients with mCRPC. Methods: We reviewed clinical and molecular data from patients with mCRPC who progressed after ≥1 ARSI and ≥1 line of taxane-based chemotherapy or were ineligible to chemotherapy, pre-screened in CYPIDES and STESIDES trials at our center. Circulating tumor DNA (ctDNA) was tested for AR LBD mutation (Guardant360 CDx and Sysmex OncoBEAM) and for genomic analysis (FoundationOne Liquid CDx, STING trial, NCT04932525) to screen for actionable targets. Results: From March 2020 to January 2022, 272 men were screened. Median age was 62y. Overall, 212 (78%), 202 (74%), and 240 (88%) patients had received previous abiraterone, enzalutamide, and docetaxel respectively. Median PSA at screening was 59 ng/mL (IQR 11; 246). ARm was found in 69 patients (25%). The most frequent mutations were L702H (15%), T878A (12%), H875Y (7%), V716M (2%), F877L (2%), W742C (1%), globally consistent with previous reports. Associations of ARm with relevant baseline characteristics of patients are summarized. Duration of enzalutamide exposure was correlated with the number of AR mutations per patient (p = 0.006) whereas no correlation was found for abiraterone exposure duration (p=0.71). In 173 (64%) patients with available genomic testing, no alterations were found to be mutually exclusive with ARm, including in DNA repair alteration. Conclusions: AR LBD mutations were detected in ctDNA in 25% of men with advanced mCRPC treated with at least one ARSI. Their incidence was associated with a longer duration of treatment with enzalutamide and a longer time from CRPC and prostate cancer diagnosis.

Association of ARm with relevant baseline characteristics and AR status.

ARwt
(N=203)
ARm
(N=69)
P value
PSA, ng/ml (median, IQR)53 (8;190)133 (37;585)<0.01
Duration of abiraterone, months (median, IQR)11m (5;22)13m (7;23)0.61
Duration of enzalutamide, months (median, IQR)6m (3;17)12m (5;24)0.01
Time between diagnosis of CRPC and pre-screening, months (median, IQR)28m (16;43)35m (23;65)<0.01
Time between prostate cancer diagnosis and pre-screening, months (median, IQR)74m (43;127)119m (56;178)0.01

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Abstract Details

Meeting

2023 ASCO Genitourinary Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session A: Prostate Cancer

Track

Prostate Cancer - Advanced,Prostate Cancer - Localized

Sub Track

Translational Research, Tumor Biology, Biomarkers, and Pathology

Citation

J Clin Oncol 41, 2023 (suppl 6; abstr 221)

DOI

10.1200/JCO.2023.41.6_suppl.221

Abstract #

221

Poster Bd #

H9

Abstract Disclosures