Baseline circulating tumor cell count as a prognostic marker of PSA response and disease progression in metastatic castrate-sensitive prostate cancer (SWOG S1216)

Amir Goldkorn*, Catherine Tangen, Melissa Plets, Gareth J. Morrison, Alexander Cunha, Tong Xu, Jacek K. Pinski, Sue A. Ingles, Timothy Triche, Andrea L. Harzstark, Manish Kohli, Gary R. MacVicar, Daniel A. Vaena, Anthony W. Crispino, David J. McConkey, Primo N. Lara, Maha H.A. Hussain, David I. Quinn, Nicholas J. Vogelzang, Ian Murchie ThompsonNeeraj Agarwal

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: In metastatic castrate-sensitive prostate cancer (mCSPC), combined androgen axis inhibition is a standard of care. Noninvasive biomarkers that guide initial therapy decisions are needed. We hypothesized that CellSearch circulating tumor cell (CTC) count, an FDA-cleared assay in metastatic castrate-resistant prostate cancer (mCRPC), is a relevant biomarker in mCSPC. Experimental Design: SWOG S1216 is a phase III prospective randomized trial of androgen deprivation therapy (ADT) combined with orteronel or bicalutamide for mCSPC. CellSearch CTC count was measured at registration (baseline). Prespecified CTC cut-off points of 0, 1-4, and ≥5 were correlated with baseline patient characteristics and, in a stratified subsample, were also correlated with two prespecified trial secondary endpoints: 7-month PSA ≤0.2 ng/mL versus 0.2-4.0 versus >4.0 (intermediate endpoint for overall survival); and progressionfree survival (PFS) ≤ versus >2 years. Results: A total of 523 patients submitted baseline samples, and CTCs were detected (median 3) in 33%. Adjusting for two trial stratification factors (disease burden and timing of ADT initiation), men with undetectable CTCs had nearly nine times the odds of attaining 7-month PSA ≤ 0.2 versus > 4.0 [OR 8.8, 95% confidence interval (CI), 2.7-28.6, P < 0.001, N = 264] and four times the odds of achieving > 2 years PFS (OR 4.0, 95% CI, 1.9-8.5, P < 0.001, N = 336) compared with men with baseline CTCs ≥5. Conclusions: Baseline CT Ccount in mCSPC is highly prognostic of 7-month PSA and 2-year PFS after adjusting for disease burden and discriminates men who are likely to experience poor survival outcomes.

Original languageEnglish (US)
Pages (from-to)1967-1973
Number of pages7
JournalClinical Cancer Research
Volume27
Issue number7
DOIs
StatePublished - Apr 2021

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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