Journal
JOURNAL OF CLINICAL ONCOLOGY
Volume 35, Issue 19, Pages 2149-+Publisher
AMER SOC CLINICAL ONCOLOGY
DOI: 10.1200/JCO.2016.70.1961
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Funding
- National Institutes of Health [R01 CA185297, P30 CA006973]
- Department of Defense Prostate Cancer Research Program [W81XWH-15-2-0050, W81XWH-12-1-0605]
- Johns Hopkins Prostate SPORE Grant [P50 CA058236]
- Patrick C. Walsh Fund
- Prostate Cancer Foundation
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Purpose We reported previously that the detection of androgen receptor splice variant-7 (AR-V7) mRNA in circulating tumor cells (CTCs) correlated with poor outcomes from the use of abiraterone and enzalutamide in patients with castration-resistant prostate cancer (CRPC). Here, we expanded our cohort size to better characterize the prognostic significance of AR-V7 in this setting. Methods We prospectively enrolled 202 patients with CRPC starting abiraterone or enzalutamide and investigated the prognostic value of CTC detection (+ v -) and AR-V7 detection (+ v -) using a CTC-based AR-V7 mRNA assay. We examined >= 50% prostate-specific antigen (PSA) responses, PSA progression-free survival, clinical and radiologic progression-free survival, and overall survival. We constructed multivariable models adjusting for PSA, Gleason sum, number of prior hormone therapies, prior abiraterone or enzalutamide use, prior taxane use, presence of visceral metastases, and Eastern Cooperative Oncology Group score. We also separately examined the first-line and second-line novel hormonal therapy (NHT) settings. Results Median follow-up times were 15.0, 21.7, and 14.6 months for CTC-, CTC+/AR-V7- and CTC+/AR-V7+ patients, respectively. CTC+/AR-V7+ patients were more likely to have Gleason scores >= 8 (P = .05), metastatic disease at diagnosis (P = .01), higher PSA (P,.01), prior abiraterone or enzalutamide use (P =.03), prior taxane use (P = .02), and Eastern Cooperative Oncology Group >= 1 (P = .01). Outcomes for the overall cohort (and separately for the first-line and second-line NHT cohorts) were best for CTC-patients, intermediate for CTC+/AR-V7-patients, and worse for CTC+/AR-V7+ patients. These correlations remained significant in multivariable models. Conclusion This expanded analysis further characterizes the importance of CTC-based AR-V7 mRNA detection in predicting outcomes in patients with CRPC receiving first-and second-line NHT and, to the best of our knowledge, is the first to suggest that this assay be interpreted using three separate prognostic categories: CTC-, CTC+/AR-V7-, and CTC+/AR-V7+. J Clin Oncol 35: 2149-2156. (C) 2017 by American Society of Clinical Oncology
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