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By: Timothy Struve, MD
Next generation sequencing and genomic tests have transformed the way we treat lung cancers and melanoma over the past several years. We can now tailor targeted therapies to attack certain mutations or cell surface receptors to individualize each patient’s care. While this level of personalization and drug targeting is not quite at the same level with prostate cancer, we are joining the genomic revolution to personalize our prostate cancer patients’ care.
There are currently five genomic prostate cancer risks tests on the market today: Prolaris, Decipher, PORTOS, Oncotype Dx, and ProstaVysion. While each have their unique properties and advantages, I do not profess the superiority of one test over another. However, at the University of Cincinnati Cancer Center, we are utilizing the Decipher test in several clinical trials that I would like to highlight here. The first is NRG-GU010. This phase III study is enrolling men with intermediate risk prostate cancer (Primarily Gleason score of 7 and PSA between 10-20) and stratifying their risk based off their Decipher genomic risk score. In this study, the Decipher score will be used to both de-intensify as well as intensify therapy. The standard of care arm on the study is radiation and short-term ADT and those with low Decipher scores may be de-intensified to radiation alone while those with high Decipher scores may be intensified to ADT with darolutamide. This study involves the largest percentage of patients that we see in our clinics, those with intermediate risk disease, and could be a major leap in personalizing prostate cancer care.
Another study we have available at the University of Cincinnati Cancer Center which utilizes the Decipher genomic risk score is the ECOG-ACRIN EA 8183 study. In this study, we are enrolling men that have undergone prostatectomy and are at high risk of recurrence. The participants will undergo Decipher genomic testing (can be done prior to or after enrollment) and if high risk (>0.6), they will be randomized to adjuvant radiation with ADT versus adjuvant radiation with ADT and the addition of Darolutamide.
These two studies represent a significant opportunity for us to personalize prostate cancer therapy to each individual patient’s risk. The hope is that intensifying therapy will improve outcomes for those at highest risk while de-intensifying therapy will reduce toxicity burden for those with more favorable outcomes. While I don’t predict that these prostate cancer genomic tests will have the impact of targeted therapies in lung cancer and melanoma, they do represent the most significant change to risk stratification in prostate cancer in several decades. It’s definitely an exciting time for prostate cancer care at the University of Cincinnati Cancer Center.
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