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TMPRSS2-ERG Status in circulating tumor cells as a predictive biomarker of sensitivity in castration-resistant prostate cancer patients treated with abiraterone acetate

Danila, Daniel C. ; Anand, Aseem LU ; Sung, Clifford C. ; Heller, Glenn ; Leversha, Margaret A. ; Cao, Long ; Lilja, Hans LU orcid ; Molina, Arturo ; Sawyers, Charles L. and Fleisher, Martin , et al. (2011) In European Urology 60(5). p.897-904
Abstract

Background: Abiraterone acetate (AA) is an androgen biosynthesis inhibitor shown to prolong life in patients with castration-resistant prostate cancer (CRPC) already treated with chemotherapy. AA treatment results in dramatic declines in prostate-specific antigen (PSA) in some patients and no declines in others, suggesting the presence of molecular determinants of sensitivity in tumors. Objective: To study the role of transmembrane protease, serine 2 (TMPRSS2)-v-ets erythroblastosis virus E26 oncogene homolog (ERG) fusion, an androgen-dependent growth factor, in circulating tumor cells (CTCs) as a biomarker of sensitivity to AA. Design, setting, and participants: The predictive value of TMPRSS2-ERG status was studied in 41 of 48 men... (More)

Background: Abiraterone acetate (AA) is an androgen biosynthesis inhibitor shown to prolong life in patients with castration-resistant prostate cancer (CRPC) already treated with chemotherapy. AA treatment results in dramatic declines in prostate-specific antigen (PSA) in some patients and no declines in others, suggesting the presence of molecular determinants of sensitivity in tumors. Objective: To study the role of transmembrane protease, serine 2 (TMPRSS2)-v-ets erythroblastosis virus E26 oncogene homolog (ERG) fusion, an androgen-dependent growth factor, in circulating tumor cells (CTCs) as a biomarker of sensitivity to AA. Design, setting, and participants: The predictive value of TMPRSS2-ERG status was studied in 41 of 48 men with postchemotherapy-treated CRPC enrolled in sequential phase 2 AA trials. Intervention: Patients received AA 1000 mg daily and continuously. Measurements: TMPRSS2-ERG status was characterized by a sensitive, analytically valid reverse transcription polymerase chain reaction assay in CTCs enriched from ethylene-diaminetetraacetic acid anticoagulated blood obtained prior to AA treatment. Outcomes were measured by PSA Working Group 1 criteria. Results and limitations: Standard procedures for specimen acquisition, processing, and testing using the validated TMPRSS2-ERG assay on a multiplex platform gave intra-assay and interassay coefficients of variation <7%. TMPRSS2-ERG fusion was present in 15 of 41 patients (37%), who had a median baseline CTC count of 17 (interquartile range: 7-103 cells per 7.5 ml). A PSA decline ≥50% was observed in 7 of 15 patients (47%) with the fusion and in 10 of 26 patients (38%) without the fusion. Although limited by the low number of patients, a posttherapy CTC count of less than five per 7.5 ml was prognostic for longer survival relative to a CTC count five or more. TMPRSS2-ERG status did not predict a decline in PSA or other clinical outcomes. Conclusions: Molecular profiles of CTCs with an analytically valid assay identified the presence of the prostate cancer-specific TMPRSS2-ERG fusion but did not predict for response to AA treatment. This finding demonstrates the role of CTCs as surrogate tissue that can be obtained in a routine practice setting. Trial registration: ClinicalTrials.gov: NCT00474383 (COU-AA-003), NCT00485303 (COU-AA-004).

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
Abiraterone, Biomarker, Circulating tumor cells, Prostate cancer, Prostate-specific antigen, TMPRSS2-ERG fusion
in
European Urology
volume
60
issue
5
pages
897 - 904
publisher
Elsevier
external identifiers
  • pmid:21802835
  • scopus:80053299958
ISSN
0302-2838
DOI
10.1016/j.eururo.2011.07.011
language
English
LU publication?
no
id
bc5c2fda-a160-4b3b-aaf5-8f2707ebcc28
date added to LUP
2022-12-06 14:46:16
date last changed
2024-04-04 15:49:50
@article{bc5c2fda-a160-4b3b-aaf5-8f2707ebcc28,
  abstract     = {{<p>Background: Abiraterone acetate (AA) is an androgen biosynthesis inhibitor shown to prolong life in patients with castration-resistant prostate cancer (CRPC) already treated with chemotherapy. AA treatment results in dramatic declines in prostate-specific antigen (PSA) in some patients and no declines in others, suggesting the presence of molecular determinants of sensitivity in tumors. Objective: To study the role of transmembrane protease, serine 2 (TMPRSS2)-v-ets erythroblastosis virus E26 oncogene homolog (ERG) fusion, an androgen-dependent growth factor, in circulating tumor cells (CTCs) as a biomarker of sensitivity to AA. Design, setting, and participants: The predictive value of TMPRSS2-ERG status was studied in 41 of 48 men with postchemotherapy-treated CRPC enrolled in sequential phase 2 AA trials. Intervention: Patients received AA 1000 mg daily and continuously. Measurements: TMPRSS2-ERG status was characterized by a sensitive, analytically valid reverse transcription polymerase chain reaction assay in CTCs enriched from ethylene-diaminetetraacetic acid anticoagulated blood obtained prior to AA treatment. Outcomes were measured by PSA Working Group 1 criteria. Results and limitations: Standard procedures for specimen acquisition, processing, and testing using the validated TMPRSS2-ERG assay on a multiplex platform gave intra-assay and interassay coefficients of variation &lt;7%. TMPRSS2-ERG fusion was present in 15 of 41 patients (37%), who had a median baseline CTC count of 17 (interquartile range: 7-103 cells per 7.5 ml). A PSA decline ≥50% was observed in 7 of 15 patients (47%) with the fusion and in 10 of 26 patients (38%) without the fusion. Although limited by the low number of patients, a posttherapy CTC count of less than five per 7.5 ml was prognostic for longer survival relative to a CTC count five or more. TMPRSS2-ERG status did not predict a decline in PSA or other clinical outcomes. Conclusions: Molecular profiles of CTCs with an analytically valid assay identified the presence of the prostate cancer-specific TMPRSS2-ERG fusion but did not predict for response to AA treatment. This finding demonstrates the role of CTCs as surrogate tissue that can be obtained in a routine practice setting. Trial registration: ClinicalTrials.gov: NCT00474383 (COU-AA-003), NCT00485303 (COU-AA-004).</p>}},
  author       = {{Danila, Daniel C. and Anand, Aseem and Sung, Clifford C. and Heller, Glenn and Leversha, Margaret A. and Cao, Long and Lilja, Hans and Molina, Arturo and Sawyers, Charles L. and Fleisher, Martin and Scher, Howard I.}},
  issn         = {{0302-2838}},
  keywords     = {{Abiraterone; Biomarker; Circulating tumor cells; Prostate cancer; Prostate-specific antigen; TMPRSS2-ERG fusion}},
  language     = {{eng}},
  number       = {{5}},
  pages        = {{897--904}},
  publisher    = {{Elsevier}},
  series       = {{European Urology}},
  title        = {{TMPRSS2-ERG Status in circulating tumor cells as a predictive biomarker of sensitivity in castration-resistant prostate cancer patients treated with abiraterone acetate}},
  url          = {{http://dx.doi.org/10.1016/j.eururo.2011.07.011}},
  doi          = {{10.1016/j.eururo.2011.07.011}},
  volume       = {{60}},
  year         = {{2011}},
}