Predictive Analytics, Genetic Biomarkers Determine Treatment Response

October 27, 2021 - Using predictive analytics, a genetic biomarker test can determine how men with high-risk prostate cancer will respond to treatment and deliver more personalized medicine.

In the study, researchers examined biopsy samples collected from three large, randomized clinical trials. According to researchers, physicians could potentially use genetic test scores to create a personalized treatment for men with the most aggressive forms of prostate cancer.

Two-thirds of prostate cancer deaths occur in patients with high-risk prostate cancer. Therefore, balancing survival risk with quality of life is important to consider when making treatment decisions. According to researchers, biomarkers could potentially be used to create precision medicine and treatment guidelines and designate who might benefit from different therapy methods.

“When a man is diagnosed with high-risk prostate cancer, we don’t have a widely accepted way to sub-classify their cancer and truly personalize their therapy, but we think we will in the near future,” lead author and professor at Harvard Medical School Paul L. Nguyen, MD, said in a public statement.

Nguyen and his team used the Decipher biopsy test, which analyzed the activity of 22 genes in prostate tumors to create scores reflecting how aggressive a patient’s cancer is.

“We are optimistic that this score can tell us which men should have their treatment de-intensified, meaning they will get less hormone therapy, and which men should have their therapy intensified, meaning they will get an additional, second-generation hormone therapy,” added Nguyen, who also holds the post of vice-chair for clinical research in the Department of Radiation Oncology at Brigham and Women’s Hospital/Dana-Farber Cancer Institute in Boston. “With this genetic marker, we hope to personalize therapy for men with high-risk prostate cancer rather than having a one-size-fits-all approach.”

Researchers calculated Decipher scores using RNA extracted from archival biopsy samples collected from three major prostate cancer trials. They then analyzed how the scores were related to long-term outcomes.

With predictive analytics, the genetic signatures indicated the patients were most likely to develop distant metastases, die from their prostate cancer, and die from other causes.

“The rate of distant cancer metastasis at 10 years was 29% for patients whose scores indicated they had more aggressive cancer, compared to 13% for those whose scores signaled lower risk,” the press release stated.

Although the Decipher test was previously validated using tissue samples taken after radical prostatectomy — the current meta-analysis studied tissue taken before treatment — at the time of initial diagnosis.

“This study is the first to validate a genetic biomarker for high-risk prostate cancer using pre-treatment archival tissue from large prospective randomized trials,” said Nguyen.

“Using archival tissue samples from a wide range of centers and patients—hundreds of cancer centers across the country—shows that this test can be helpful for many men with high-risk disease.”

The age of the samples also meant that researchers could study the long-term outcomes of patients with high-risk prostate tumors. “A strength of using this tissue is that we have the complete follow-up for 20 to 30 years on these patients,” said Nguyen.

“For a man with high-risk prostate cancer, this genetic score can be a very powerful prognostic tool that can tell us whether he is likely to be cured from treatment or is likely to see his cancer return again. I see this as a great opportunity to change the standard of care for patients in the future by using genomics to personalize therapy.”