There are around 55,100 new prostate cancer cases in the UK every year and 12,000 men are expected to die from prostate cancer this year. Prostate cancer is the second most common cause of cancer death in males in the UK, accounting for 14% of all cancer deaths in this group. Most prostate cancer deaths occur in patients who first presented with advanced or metastatic disease. According to a new study led by UCL researchers, testing the molecular profile of tumors identifies which patients with advanced prostate cancer are more likely to benefit from chemotherapy and live longer, sparing patients less likely to benefit from unpleasant side effects. The study is the first strong evidence that a gene expression test performed on routinely collected prostate tissue can help guide therapy choices for prostate cancer patients whose cancer has spread (metastasis).
The test is called the Decipher Prostate Genomic Classifier test and is manufactured by Veracyte. The study included 1,523 patients recruited to the STAMPEDE phase III trials, that had been diagnosed with advanced prostate cancer and started treatment with androgen deprivation therapy (ADT), which blocks male hormones such as testosterone that can drive prostate cancer growth. The STAMPEDE trials tested the additional benefit of adding abiraterone or docetaxel to ADT and the study patients were followed up for a median of 14 years. Among the 832 patients with metastatic prostate cancer, those with high Decipher Prostate scores had a 36% reduction in the risk of death after treatment with docetaxel, while those with lower Decipher scores had a reduction in the risk of death that was estimated at less than 4%.
This finding is significant as while docetaxel chemotherapy improves survival for some patients, it also reduces quality of life. This test may be used to identify which patients are likely to have docetaxel-sensitive tumors and live longer with docetaxel chemotherapy treatment. The Decipher Prostate test is already widely used in the US to help identify localised prostate cancer more likely to spread. It becomes the first molecular test with clinical evidence from a randomised trial showing it can guide treatment choices for metastatic prostate cancer. Treatment intensification with docetaxel, in addition to standard ADT, can improve survival for patients with metastatic prostate cancer. However, response rates vary, and clinicians have limited tools to identify who is likely to benefit and who is not.
Veracyte’s Decipher Prostate test addresses this gap by providing a more personalised approach to treatment decisions. In addition to identifying the first commercially available test that can predict docetaxel efficacy, the collaboration has also identified several new molecular classifiers that predict outcomes of patients. Globally, there are no other metastatic patients prospectively directly randomized to docetaxel, so supportive data could be generated in other trials that included docetaxel as standard of care. The STAMPEDE trial has resulted in several changes to the way patients presenting with advanced prostate cancer are treated. The trial is funded by Cancer Research UK and led by researchers at the UCL MRC Clinical Trials Unit and UCL Cancer Institute. The trial aims to find new treatment approaches for advanced prostate cancer.
- Edited by Dr. Gianfrancesco Cormaci, PhD, specialist in Clinical Biochemistry.
Scientific references
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