1. Plasma tumor gene conversions after one cycle abiraterone acetate for metastatic castration-resistant prostate cancer: a biomarker analysis of a multicenter international trial
- Author
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Alfredo Berruti, Daniel Wetterskog, Marjolein Lahaye, Anna Wingate, K. Garg, F. Meacham, Cora N. Sternberg, Robert Jones, Florence Lefresne, Deborah Ricci, Bertrand Tombal, Shibu Thomas, G. Attard, Michael Gormley, L.P. Lim, Axel S. Merseburger, Graham M. Wheeler, Anuradha Jayaram, UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, and UCL - (SLuc) Service d'urologie
- Subjects
Male ,0301 basic medicine ,Oncology ,medicine.medical_specialty ,plasma DNA ,PALB2 ,Abiraterone Acetate ,Gene Conversion ,Phases of clinical research ,Single-nucleotide polymorphism ,Castration-Resistant ,Androgen ,liquid biopsies ,03 medical and health sciences ,chemistry.chemical_compound ,Prostate cancer ,0302 clinical medicine ,Internal medicine ,Receptors ,Biomarkers, Tumor ,Humans ,Medicine ,PTEN ,CHEK2 ,Tumor ,biology ,business.industry ,Prostate Cancer ,Hazard ratio ,Abiraterone acetate ,biomarkers ,Prostatic Neoplasms ,genomic alterations ,Hematology ,next-generation sequencing ,prostate cancer ,Receptors, Androgen ,Treatment Outcome ,Prostatic Neoplasms, Castration-Resistant ,medicine.disease ,030104 developmental biology ,chemistry ,030220 oncology & carcinogenesis ,biology.protein ,business - Abstract
BACKGROUND: Plasma tumor DNA fraction is prognostic in metastatic cancers. This could improve risk stratification before commencing a new treatment. We hypothesized that a second sample collected after one cycle of treatment could refine outcome prediction of patients identified as poor prognosis based on plasma DNA collected pre-treatment. PATIENTS AND METHODS: Plasma DNA [128 pre-treatment, 134 cycle 2 day 1 (C2D1), and 49 progression] from 151 chemotherapy-naive metastatic castration-resistant prostate cancer (mCRPC) patients in a phase II study of abiraterone acetate (NCT01867710) were subjected to custom targeted next-generation sequencing covering exons of these genes: TP53, AR, RB1, PTEN, PIK3CA, BRCA1, BRCA2, ATM, CDK12, CHEK2, FANCA HDAC2 and PALB2. We also captured 1500 pan-genome regions enriched for single nucleotide polymorphisms to allow detection of tumor DNA using the rolling B-allele method. We tested associations with overall survival (OS) and progression-free survival (PFS). RESULTS: Plasma tumor DNA detection was associated with shorter OS [hazard ratio (HR): 2.89, 95% confidence intervals (CI): 1.77-4.73, P ≤ 0.0001] and PFS (HR: 2.05; 95% CI: 1.36-3.11, P < 0.001). Using a multivariable model including plasma tumor DNA, patients who had a TP53, RB1 or PTEN gene alteration pre-treatment and at C2D1 had a significantly shorter OS than patients with no alteration at either time point (TP53: HR 7.13, 95% CI 2.37-21.47, P < 0.001; RB1: HR 6.24, 95% CI 1.97-19.73, P = 0.002; PTEN: HR 11.9, 95% CI 3.6-39.34, P < 0.001). Patients who were positive pre-treatment and converted to undetectable had no evidence of a difference in survival compared with those who were undetectable pre-treatment (P = 0.48, P = 0.43, P = 0.5, respectively). Progression samples harbored AR gain in all patients who had gain pre-treatment (9/49) and de novo AR somatic point mutations were detected in 8/49 patients. CONCLUSIONS: Plasma gene testing after one cycle treatment refines prognostication and could provide an early indication of treatment benefit.
- Published
- 2021