A new meta-analysis finds that a genetic biomarker test accurately predicts how men with high-risk prostate cancer will respond to treatment with radiation and hormone therapy. The study, which examined biopsy samples collected from three large, randomized clinical trials, indicates that physicians potentially can use genetic test scores to personalize treatment for men with the most aggressive form of prostate cancer. Findings will be presented today at the American Society for Radiation Oncology (ASTRO) Annual Meeting.
Two-thirds of prostate cancer deaths occur in patients with high-risk prostate cancer, for whom standard treatment involves radiation therapy and two years of hormone therapy. Balancing survival risk with quality of life is an important consideration for many men with this disease. Hormone therapy can cause difficult side effects, including hot flashes, loss of libido and possible cardiovascular and cognitive changes. Researchers believe that biomarkers could potentially be used to develop more precise treatment guidelines and designate who might benefit from less therapy or who might benefit from additional treatment with newer hormonal agents.
"When a man is diagnosed with high-risk prostate cancer, we don't have a widely accepted way to sub-classify their cancer and truly personalize their therapy, but we think we will in the near future," said lead author Paul L. Nguyen, MD, a professor at Harvard Medical School and vice chair for clinical research in the department of radiation oncology at Brigham and Women's Hospital/Dana-Farber Cancer Institute in Boston.
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Dr. Nguyen and his team utilized the Decipher biopsy test, which analyzes the activity of 22 genes in prostate tumors to produce a score reflecting how aggressive a patient's cancer is. "We are optimistic that this score can tell us which men should have their treatment de-intensified, meaning they will get less hormone therapy, and which men should have their therapy intensified, meaning they will get an additional, second-generation hormone therapy," said Dr. Nguyen. "With this genetic marker, we hope to personalize therapy for men with high-risk prostate cancer rather than having a one-size-fits-all approach."
Researchers calculated Decipher scores using RNA extracted from archival biopsy samples collected in three major prostate cancer trials (RTOG-9202, n=90; RTOG-9413, n=172; RTOG-9902, n=123). Then, they examined how closely these Decipher scores were associated with long-term outcomes.