Plasma Cell-free DNA Concentration and Outcomes from Taxane Therapy in Metastatic Castration-resistant Prostate Cancer from Two Phase III Trials (FIRSTANA and PROSELICA)

Noninvasive biomarkers are needed to guide metastatic castration-resistant prostate cancer (mCRPC) treatment.

To clinically qualify baseline and on-treatment cell-free DNA (cfDNA) concentrations as biomarkers of patient outcome following taxane chemotherapy.

Blood for cfDNA analyses was prospectively collected from 571 mCRPC patients participating in two phase III clinical trials, FIRSTANA (NCT01308567) and PROSELICA (NCT01308580). Patients received docetaxel (75mg/m2) or cabazitaxel (20 or 25mg/m2) as first-line chemotherapy (FIRSTANA), and cabazitaxel (20 or 25mg/m2) as second-line chemotherapy (PROSELICA).

Associations between cfDNA concentration and prostate-specific antigen (PSA) response were tested using logistic regression models. Survival was estimated using Kaplan-Meier methods for cfDNA concentration grouped by quartile. Cox proportional hazard models, within each study, tested for associations with radiological progression-free survival (rPFS) and overall survival (OS), with multivariable analyses adjusting for baseline prognostic variables. Two-stage individual patient meta-analysis combined results for cfDNA concentrations for both studies.

In 2502 samples, baseline log10cfDNA concentration correlated with known prognostic factors, shorter rPFS (hazard ratio [HR]=1.54; 95% confidence interval [CI]: 1.15-2.08; p=0.004), and shorter OS on taxane therapy (HR=1.53; 95% CI: 1.18-1.97; p=0.001). In multivariable analyses, baseline cfDNA concentration was an independent prognostic variable for rPFS and OS in both first- and second-line chemotherapy settings. Patients with a PSA response experienced a decline in log10cfDNA concentrations during the first four cycles of treatment (per cycle -0.03; 95% CI: -0.044 to -0.009; p=0.003). Study limitations included the fact that blood sample collection was not mandated for all patients and the inability to specifically quantitate tumour-derived cfDNA fraction in cfDNA.

We report that changes in cfDNA concentrations correlate with both rPFS and OS in patients receiving first- and second-line taxane therapy, and may serve as independent prognostic biomarkers of response to taxanes.

In the past decade, several new therapies have been introduced for men diagnosed with metastatic prostate cancer. Although metastatic prostate cancer remains incurable, these novel agents have extended patient survival and improved their quality of life in comparison with the last decade. To further optimise treatment allocation and individualise patient care, better tests (biomarkers) are needed to guide the delivery of improved and more precise care. In this report, we assessed cell-free DNA in over 2500 blood samples from men with prostate cancer who were recruited to two separate international studies and received taxane chemotherapy. We quantified the concentration of cell-free DNA fragments in blood plasma, which partly originates from tumour. We identified that higher concentrations of circulating cell-free DNA fragments, prior to starting taxane chemotherapy, can be used to identify patients with aggressive prostate cancer. A decline in cell-free DNA concentration during the first 3-9 wk after initiation of taxane therapy was seen in patients deriving benefit from taxane chemotherapy. These results identified circulating cell-free DNA as a new biomarker of aggressive disease in metastatic prostate cancer and imply that the study of cell-free DNA has clinical utility, supporting further efforts to develop blood-based tests on this circulating tumour-derived DNA.

European urology. 2018 Feb 27 [Epub ahead of print]

Niven Mehra, David Dolling, Semini Sumanasuriya, Rossitza Christova, Lorna Pope, Suzanne Carreira, George Seed, Wei Yuan, Jane Goodall, Emma Hall, Penny Flohr, Gunther Boysen, Diletta Bianchini, Oliver Sartor, Mario A Eisenberger, Karim Fizazi, Stephane Oudard, Mustapha Chadjaa, Sandrine Macé, Johann S de Bono

Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, UK., The Institute of Cancer Research, London, UK., Tulane University School of Medicine, New Orleans, LA, USA., The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA., Department of Medical Oncology, Institut Gustave Roussy, University of Paris Sud, Villejuif, France., Department of Medical Oncology, Hôpital Européen Georges Pompidou, Paris, France., Sanofi, Paris, France., Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, UK. Electronic address: .