Circulating tumor cell chromosomal instability and neuroendocrine phenotype by immunomorphology and poor outcomes in men with mCRPC treated with abiraterone or enzalutamide

Landon C. Brown, Susan Halabi, Joseph D. Schonhoft, Qian Yang, Jun Luo, David M. Nanus, Paraskevi Giannakakou, Russell Z. Szmulewitz, Daniel C. Danila, Ethan S. Barnett, Emily A. Carbone, Jimmy L. Zhao, Patrick Healy, Monika Anand, Audrey Gill, Adam Jendrisak, William R. Berry, Santosh Gupta, Simon G. Gregory, Richard WenstrupEmmanuel Antonarakis, Daniel J. George, Howard I. Scher, Andrew J. Armstrong

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: While the detection of AR-V7 in circulating tumor cells (CTC) is associated with resistance to abiraterone or enzalutamide in men with metastatic castration-resistant prostate cancer (mCRPC), it only accounts for a minority of this resistance. Neuroendocrine (NE) differentiation or chromosomal instability (CIN) may be additional mechanisms that mediate resistance. Experimental Design: PROPHECY was a multicenter prospective study of men with high-risk mCRPC starting abiraterone or enzalutamide. A secondary objective was to assess Epic CTC CIN and NE phenotypes before abiraterone or enzalutamide and at progression. The proportional hazards (PH) model was used to investigate the prognostic importance of CIN and NE in predicting progression-free survival and overall survival (OS) adjusting for CTC number (CellSearch), AR-V7, prior therapy, and clinical risk score. The PH model was utilized to validate this association of NE with OS in an external dataset of patients treated similarly at Memorial Sloan Kettering Cancer Center (MSKCC; New York, NY). Results: We enrolled 118 men with mCRPC starting on abiraterone or enzalutamide; 107 were evaluable on the Epic platform. Of these, 36.4% and 8.4% were CIN positive and NE positive, respectively. CIN and NE were independently associated with worse OS [HR, 2.2; 95% confidence interval (CI), 1.2–4.0 and HR 3.8; 95% CI, 1.2–12.3, respectively] when treated with abiraterone/enzalutamide. The prognostic significance of NE positivity for worse OS was confirmed in the MSKCC dataset (n ¼ 173; HR, 5.7; 95% CI, 2.6–12.7). Conclusions: A high CIN and NE CTC phenotype is independently associated with worse survival in men with mCRPC treated with abiraterone/enzalutamide, warranting further prospective controlled predictive studies to inform treatment decisions.

Original languageEnglish (US)
Pages (from-to)4077-4088
Number of pages12
JournalClinical Cancer Research
Volume27
Issue number14
DOIs
StatePublished - Jul 15 2021

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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