Determinants of widespread metastases and of metastatic tropism in patients with prostate cancer: A genomic analysis of primary and metastatic tumors.

Authors

Edward Dee

Edward Christopher Dee

Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY

Edward Christopher Dee , Alexander G Goglia , Nishwant Swami , Bastien Nguyen , Helen Y Hougen , Anwar Khan , Amar Upadhyaya Kishan , Sanoj Punnen , Paul L. Nguyen , Brandon A Mahal , Mohamed Alshalalfa

Organizations

Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, Memorial Sloan Kettering Cancer Center, New York, NY, University of Massachusetts Medical School, Worcester, MA, Desai Sethi Urology Institute, University of Miami, Miami, FL, University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL, UCLA Department of Radiation Oncology, Los Angeles, CA, University of Miami, Miami, FL, Brigham and Women's Hospital, Boston, MA, University of Miami Miller School of Medicine, Miami, FL

Research Funding

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

Background: A growing body of evidence suggests that metastatic cancer is better described as a spectrum of disease rather than a binarily defined state, ranging from oligometastatic cancer to widespread metastases. Widespread metastases represent the most common cause of cancer-related death among patients with prostate cancer. Therefore, a greater understanding of the genomic features that determine the extent and location of metastatic spread may inform risk stratification, treatment, and monitoring. We identify genomic alterations from primary prostate tumors that are predictive of widespread metastatic potential. Methods: Genomic and clinical data for 1,312 patients with primary prostate adenocarcinomas were extracted from the MSK-MET cohort through cBioPortal. Metastatic site counts and overall survival (OS) data were publicly available for all patients. All samples from primary tumors were profiled using the MSK-IMPACT targeted sequencing platform. Our study focused on 58 genes frequently altered in prostate cancer. Cox proportional hazard analyses defined hazard ratios (HRs) and 95% confidence intervals (CIs) for overall mortality in patients with different metastatic outcomes. Patterns of genomic alterations of the primary tumor associated with metastatic extent and location were compared. Results: Out of 1,312 patients, 939 (71%) developed metastases, and 113 (8.6%) had metastases to 5 or more distinct anatomical sites (defining wide-spread metastases, WSM). Bone was the most common site of metastasis (36%), and 80% of patients with liver metastases had 4 or more additional sites of metastasis. Among patients with metastases, increasing number of metastatic sites was associated with increased risk of death (HR:1.8, 95%CI:1.63-1.99, p<0.001). To define genomic determinants of WSM, we characterized genomic alterations in 58 prostate cancer related genes. Alterations in the following genes were enriched in tumors from patients with WSM vs others: TP53 mutation (40% vs 20%, p<0.0001), FOXA1-amplification (8% vs 3%, p=0.02), AR-amplification (4.4% vs 1%, p=0.01), RB1-deletion (5.3% vs 0.7%, p=0.001), and BRCA2-deletion (4.4% vs 0.7%, p=0.01). In a univariable survival analysis, all these alterations were predictive of OS (p<0.05). However, on multivariable analysis, only TP53 mutations, and FOXA1 and AR amplifications were independent prognostic factors. Amplifications of FOXA1 (n=37) and AR (n=13) were mutually exclusive (0 overlap), and we found that patients who have either AR or FOXA1 amplifications experienced very poor OS (HR:3.57, 95%CI:2.26-5.6, p p<0.001]. Conclusions: We identified genomic alterations (TP53 mutations, FOXA1 and AR amplification, RB1 and BRCA2 deletions) from primary prostate tumors that are predictive of wide-spread metastases and poor outcomes.

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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– Advanced/Castrate-Resistant

Citation

J Clin Oncol 41, 2023 (suppl 16; abstr 5067)

DOI

10.1200/JCO.2023.41.16_suppl.5067

Abstract #

5067

Poster Bd #

161

Abstract Disclosures

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