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Genomic Heterogeneity Within Individual Prostate Cancer Foci Impacts Predictive Biomarkers of Targeted Therapy

2018; Elsevier BV; Volume: 5; Issue: 3 Linguagem: Inglês

10.1016/j.euf.2018.01.006

2405-4569

David J. VanderWeele, Richard Finney, Kotoe Katayama, Marc Gillard, Gladell P. Paner, Seiya Imoto, Rui Yamaguchi, David Wheeler, Justin Lack, Maggie Cam, Andrea Pontier, Yen Thi Minh Nguyen, Kazuhiro Maejima, Aya Sasaki-Oku, Kaoru Nakano, Hiroko Tanaka, Donald J. Vander Griend, Michiaki Kubo, Mark J. Ratain, Satoru Miyano, Hidewaki Nakagawa,

Statistical Methods in Clinical Trials

BackgroundMost lethal prostate cancers progress from relapse of aggressive primary disease. Recently, the most significant advances in survival benefit from systemic therapy have come from moving the administration of therapy to an earlier disease state. There is movement toward using biomarkers from the intraprostatic index lesion to guide early systemic therapy.ObjectiveTo determine the genomic heterogeneity, including the heterogeneity of predictive biomarkers, within the index focus of treatment-naïve prostate cancer.Design, setting, and participantsTen patients with treatment-naïve prostate cancer underwent prostatectomy. DNA was extracted from 70 spatially distinct regions of the 10 index foci.Outcome measurements and statistical analysisSingle nucleotide mutations, small indels, and copy number changes were identified. Intrafocal genomic heterogeneity and heterogeneity of alterations that predict response to therapy was determined.Results and limitationsExome sequencing and copy number estimates demonstrate branched evolution with >75% of point mutations being subclonal, including numerous pathways associated with castrate-resistant prostate cancer. Seven of 10 patients harbor alterations in one of five genes that predict response to targeted therapies with survival benefit in prostate cancer. Within biomarker-positive cases, 25% of intraprostatic regions are biomarker negative, with discordance between intraprostatic regions and lymph node metastases.ConclusionsTreatment-naïve, nonmetastatic prostate cancer has marked intrafocal heterogeneity. Numerous alterations in pathways associated with castration-resistant prostate cancer are present in subclonal populations, including biomarkers predictive of response to targeted therapy.Patient summaryUntreated patients' tumors have alterations that predict response to targeted therapies, but the presence of a biomarker is dependent on what region of the tumor was evaluated.