Basal-luminal subtyping of localized high-risk prostate cancer and benefit of adding docetaxel to definitive radiotherapy with androgen suppression in the NRG Oncology/RTOG 0521 phase III trial.

Authors

null

Ryan Phillips

Mayo Clinic, Rochester, MN

Ryan Phillips , James A. Proudfoot , Elai Davicioni , Yang Liu , Daniel Eidelberg Spratt , Felix Y Feng , Jeff Simko , Robert Benjamin Den , Alan Pollack , Seth A. Rosenthal , A. Oliver Sartor , Christopher Sweeney , Gerhardt Attard , Samir Patel , Michael Wayne Straza , Jason A. Efstathiou , Amit Shah , Joseph P. Rodgers , Howard M. Sandler , Phuoc T. Tran

Organizations

Mayo Clinic, Rochester, MN, Veracyte, Inc., San Francisco, CA, University Hospitals Cleveland Medical Center, Cleveland, OH, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, University of California, San Francisco, San Francisco, CA, Jefferson Kimmel Cancer Center, Philadelphia, PA, University of Miami Health System, Miami, FL, Department of Radiation Oncology, Sutter Medical Group, Sacramento, CA, Tulane Cancer Center, Tulane University School of Medicine, New Orleans, LA, South Australian Immunogenomics Cancer Institute, University of Adelaide, Adelaide, Australia, Institute of Cancer Research, University College, London, United Kingdom, Cross Cancer Institute, Edmonton, AB, Canada, Medical College of Wisconsin, Milwaukee, WI, Massachusetts General Hospital, Boston, MA, Wellspan Health, York, PA, NRG Oncology Statistics and Data Management Center, American College of Radiology, Philadelphia, PA, Cedars-Sinai Medical Center, Los Angeles, CA, University of Maryland, Baltimore, MD

Research Funding

U.S. National Institutes of Health
U.S. National Institutes of Health, Sanofi

Background: In prior studies, basal vs. luminal differentiation portends differential response to a) androgen suppression (AS) duration for high-risk prostate cancer (PCa) (NRG-GU-TS006) and b) docetaxel chemotherapy (CT) and AS for metastatic hormone-sensitive disease (CHAARTED). In NRG-GU-TS006, basal tumors appeared to benefit the most from longer duration of AS while those with luminal subtype did not whereas, in CHAARTED, luminal subtype had greater benefit from addition of CT. Herein, we examined basal-luminal subtyping to predict differential response to the addition of CT in the setting of high-risk PCa treated with AS and definitive radiotherapy (AS + RT) in NRG/RTOG 0521. Methods: Per pre-specified and approved NCI analysis plan (Navigator #1061), we obtained available NRG biobank biopsy specimens from patients enrolled on the NRG/RTOG 0521 phase III trial, which randomized patients to AS + RT +/- CT. The highest-grade tumors were profiled on clinical-grade whole-transcriptome arrays (Veracyte, San Diego, CA). Basal-luminal subtypes were generated using a 215-gene PCa subtyping classifier (PSC), a second generation PAM50 basal-luminal model. Treatment effects in Luminal Proliferating (LP) and non-LP subtypes were examined with Cox (for overall survival, OS, and metastasis-free survival, MFS) and Fine & Gray (for distant metastasis, DM) multivariable (MVA) models adjusted for age and trial risk stratification, as well as with restricted mean survival times (RMST). Results: Of 183 samples available for analysis (91 from control and 92 from the CT arm), 52 (28%) were classified as LP subtype. Median follow-up for OS was 9.9 years. No significant differences in clinical or pathological variables were observed between LP and non-LP subtypes. In MVA, we did not detect any significant LP subtype-by-CT treatment interaction but observed evidence of non-proportional hazards (Grambsch-Therneau test, p<0.05). In unselected patients, 5- and 10-year RMST difference between the arms was 0.9 (95% CI [-1.5, 3.4], p=0.46) and 5.7 (95% CI [-2.5, 13.9], p=0.17) months of OS. Stratifying by tumor subtype, at 5 years the RMST difference in months was 3.8 (95% CI [0.3, 7.2], p=0.03) for LP and -0.2 ([-3.4, 2.9], p=0.89) for non-LP. The RMST difference in months at 10-years was 13.7 (95% CI [-0.2, 27.5], p=0.053) for LP and 2.5 ([-7.6, 12.5], p=0.63) for non-LP. Conclusions: In pre-treatment biopsy samples from a Phase 3 trial cohort of localized high-risk men, luminal-basal subtyping of tumors demonstrated differential response to docetaxel CT. Similar to results from the CHAARTED trial of metastatic disease, LP tumors may derive greater benefit from addition of CT. Validation of these findings may enable effective earlier use of CT in men with PCa.

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Abstract Details

Meeting

2023 ASCO Annual Meeting

Session Type

Poster 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 41, 2023 (suppl 16; abstr 5094)

DOI

10.1200/JCO.2023.41.16_suppl.5094

Abstract #

5094

Poster Bd #

188

Abstract Disclosures