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The main challenge in the de novo M1 castrate sensitive setting is that any prior ADT (without disease progression) will significantly reduce ctDNA. At the Vancouver Prostate Centre, they have made a concerted effort to collect true baseline samples in patients (40 patients in the past year) with de novo M1 disease. In the first 24 patients examined to date, 12 patients had ctDNA >2% (50% of patients), which is lower than 1st line CRPC (60%) and 2nd/3rd line CRPC (80%).
Dr. Wyatt concluded with several important take-home messages:
- • ctDNA is an effective tool to identify somatic mutations and copy number alterations in the majority of men with mCRPC
- • ctDNA is highly representative of matched metastatic tissue biopsy
- • ctDNA shows promise in the castrate-sensitive setting for capturing somatic information, but prior ADT is a strong confounder
- • Preliminary results suggest opportunities for guiding therapy intensification/combination therapy
Presented by: Dr. Alexander Wyatt, B.Sc.D.Phil Vancouver Prostate Centre, Vancouver, BC, Canada
Written by: Zachary Klaassen, MD, Society of Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre @zklaassen_md at the 18th Annual Meeting of the Society of Urologic Oncology, November 20-December 1, 2017 – Washington, DC