Diagnostic test could help doctors refine prostate cancer treatment
· Medical Xpressedited by Sadie Harley, reviewed by Andrew Zinin
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Prostate cancer is the most common cancer in men—in 2013, it affected more than 1 million men across the world. The cancer does not behave the same way in every patient, and doctors have long faced a difficult balancing act between identifying patients who will benefit from more intensive treatment and those who may do just as well without it. Treating someone more aggressively than necessary is associated with increased side effects and poorer quality of life.
At a major cancer conference in Madrid, a team from University College London unveiled the latest findings from their STAMPEDE clinical trial, which has shown that adding the hormone therapy abiraterone to the standard treatment for men with high-risk, localized prostate cancer could halve the risk of death from the disease and slow overall progression.
However, not all trials have shown that adding extra hormonal therapies to high-risk prostate cancer is beneficial, and in their new study, the researchers wanted to know whether an additional test—the Decipher tissue-based molecular test—could be used to determine which patients would benefit most from more intensive treatment. Side effects of abiraterone include fatigue.
The UCL team analyzed Decipher scores from two datasets—real-world data of 27,607 (of which 5,956 were analyzed for outcomes) and 401 men with non-metastatic prostate cancer randomized within the STAMPEDE abiraterone trial.
They found that higher Decipher scores consistently predicted worse outcomes—for every 0.1 increase in the score, the risk of distant metastasis increased with an adjusted hazard ratio of 1.49 and the risk of dying of prostate cancer had a hazard ratio of 1.38.
The Decipher score predicted which patients whose cancers have not yet spread to their lymph nodes would benefit from the addition of abiraterone in preventing the cancer's spread to distant parts of the body.
The study's lead researcher, Dr. Sarah Howlett (UCL Cancer Institute), who presented the findings, said, "For men with very high-risk prostate cancer, preventing the cancer from spreading is critical, and understanding who benefits most from additional treatment can make a meaningful difference.
"Our findings suggest that a genomic test could help personalize treatment: men with high-risk disease but a low Decipher score have low rates of cancer spread and could potentially be spared more intensive treatment, while men with a high score could be prioritized for it.
"Showing the same pattern in both a large real-world dataset and a randomized clinical trial strengthens the findings. But further validation in other datasets is needed before the test is used routinely to make these decisions."
In January, NHS England announced it would be rolling out the use of abiraterone to treat men in England with high-risk locally advanced prostate cancer within weeks. Patients with similar risk profiles in Wales and Scotland already had access to the drug on the NHS. In the U.K., the standard treatment for prostate cancer is androgen deprivation therapy.
Elai Davicioni, medical director, urology for U.S. cancer diagnostics firm Veracyte, which makes the Decipher test, said, "We believe this growing evidence gives physicians a stronger reason to use Decipher before making decisions that can affect both cancer outcomes and patients' quality of life.
"These findings expand Decipher's predictive evidence to another consequential treatment decision: whether adding abiraterone will provide meaningful benefit for a man with very high-risk prostate cancer."
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Sadie Harley
BSc Life Sciences & Ecology. Microbiology lab background with pharmaceutical news experience in oil, gas, and renewable industries. Full profile →
Andrew Zinin
Master's in physics with research experience. Long-time science news enthusiast. Plays key role in Science X's editorial success. Full profile →
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