Veracyte, Inc. and University College London (UCL) announced that data published online in Cell show that the Decipher Prostate Genomic Classifier predicts which patients with metastatic cancer are likely to benefit from treatment intensification with the chemotherapy docetaxel and which are not likely to benefit and can therefore avoid unnecessary toxicity.
The findings—from the randomized, prospective, Phase 3 STAMPEDE trial—are the first to be published showing that a gene expression test can help clinicians better personalize chemotherapy decisions for patients with metastatic prostate cancer.
The study involved 1523 patients with high-risk or metastatic prostate cancer who were randomized to standard-of-care treatment with androgen deprivation therapy (ADT) or to chemotherapy plus ADT. Patients were then followed for a median of 14 years. Among the 832 patients with metastatic prostate cancer, those with higher Decipher Prostate scores had improved survival benefit (HR 0.64, 95% CI 0.48-0.86) from docetaxel, while those with lower Decipher scores did not (HR 0.96, 95% CI 0.71-1.30; biomarker-treatment interaction p=0.039).
The findings remained consistent, regardless of each patient’s metastatic disease volume. This is important because current clinical practice favors use of docetaxel in patients with high- but not low-volume disease.
For the current study, Veracyte performed whole-transcriptome analysis of all prostate samples. In addition to the commercially available Decipher Prostate test, other research-use-only gene signatures were evaluated. One notable finding was that metastatic tumors with both a high Decipher Prostate test score and a PTEN-inactive gene signature had the greatest benefit from the addition of docetaxel, suggesting potential opportunities to enable further-personalized patient care in the future.
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