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Prospective Multicenter Validation of Androgen Receptor Splice Variant 7 and Hormone Therapy Resistance in High-Risk Castration-Resistant Prostate Cancer: The PROPHECY Study.

Publication ,  Journal Article
Armstrong, AJ; Halabi, S; Luo, J; Nanus, DM; Giannakakou, P; Szmulewitz, RZ; Danila, DC; Healy, P; Anand, M; Rothwell, CJ; Rasmussen, J; Lu, C ...
Published in: J Clin Oncol
May 1, 2019

PURPOSE: Androgen receptor splice variant 7 (AR-V7) results in a truncated receptor, which leads to ligand-independent constitutive activation that is not inhibited by anti-androgen therapies, including abiraterone or enzalutamide. Given that previous reports suggested that circulating tumor cell (CTC) AR-V7 detection is a poor prognostic indicator for the clinical efficacy of secondary hormone therapies, we conducted a prospective multicenter validation study. PATIENTS AND METHODS: PROPHECY ( ClinicalTrials.gov identifier: NCT02269982) is a multicenter, prospective-blinded study of men with high-risk mCRPC starting abiraterone acetate or enzalutamide treatment. The primary objective was to validate the prognostic significance of baseline CTC AR-V7 on the basis of radiographic or clinical progression free-survival (PFS) by using the Johns Hopkins University modified-AdnaTest CTC AR-V7 mRNA assay and the Epic Sciences CTC nuclear-specific AR-V7 protein assay. Overall survival (OS) and prostate-specific antigen responses were secondary end points. RESULTS: We enrolled 118 men with mCRPC who were starting abiraterone or enzalutamide treatment. AR-V7 detection by both the Johns Hopkins and Epic AR-V7 assays was independently associated with shorter PFS (hazard ratio, 1.9 [95% CI, 1.1 to 3.3; P = .032] and 2.4 [95% CI, 1.1 to 5.1; P = .020], respectively) and OS (hazard ratio, 4.2 [95% CI, 2.1 to 8.5] and 3.5 [95% CI, 1.6 to 8.1], respectively) after adjusting for CTC number and clinical prognostic factors. Men with AR-V7-positive mCRPC had fewer confirmed prostate-specific antigen responses (0% to 11%) or soft tissue responses (0% to 6%). The observed percentage agreement between the two AR-V7 assays was 82%. CONCLUSION: Detection of AR-V7 in CTCs by two blood-based assays is independently associated with shorter PFS and OS with abiraterone or enzalutamide, and such men with mCRPC should be offered alternative treatments.

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Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

May 1, 2019

Volume

37

Issue

13

Start / End Page

1120 / 1129

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Reproducibility of Results
  • Receptors, Androgen
  • Protein Isoforms
  • Prostatic Neoplasms, Castration-Resistant
  • Prospective Studies
  • Progression-Free Survival
  • Predictive Value of Tests
  • Phenylthiohydantoin
  • Oncology & Carcinogenesis
 

Citation

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Armstrong, A. J., Halabi, S., Luo, J., Nanus, D. M., Giannakakou, P., Szmulewitz, R. Z., … George, D. J. (2019). Prospective Multicenter Validation of Androgen Receptor Splice Variant 7 and Hormone Therapy Resistance in High-Risk Castration-Resistant Prostate Cancer: The PROPHECY Study. J Clin Oncol, 37(13), 1120–1129. https://doi.org/10.1200/JCO.18.01731
Armstrong, Andrew J., Susan Halabi, Jun Luo, David M. Nanus, Paraskevi Giannakakou, Russell Z. Szmulewitz, Daniel C. Danila, et al. “Prospective Multicenter Validation of Androgen Receptor Splice Variant 7 and Hormone Therapy Resistance in High-Risk Castration-Resistant Prostate Cancer: The PROPHECY Study.J Clin Oncol 37, no. 13 (May 1, 2019): 1120–29. https://doi.org/10.1200/JCO.18.01731.
Armstrong AJ, Halabi S, Luo J, Nanus DM, Giannakakou P, Szmulewitz RZ, et al. Prospective Multicenter Validation of Androgen Receptor Splice Variant 7 and Hormone Therapy Resistance in High-Risk Castration-Resistant Prostate Cancer: The PROPHECY Study. J Clin Oncol. 2019 May 1;37(13):1120–9.
Armstrong, Andrew J., et al. “Prospective Multicenter Validation of Androgen Receptor Splice Variant 7 and Hormone Therapy Resistance in High-Risk Castration-Resistant Prostate Cancer: The PROPHECY Study.J Clin Oncol, vol. 37, no. 13, May 2019, pp. 1120–29. Pubmed, doi:10.1200/JCO.18.01731.
Armstrong AJ, Halabi S, Luo J, Nanus DM, Giannakakou P, Szmulewitz RZ, Danila DC, Healy P, Anand M, Rothwell CJ, Rasmussen J, Thornburg B, Berry WR, Wilder RS, Lu C, Chen Y, Silberstein JL, Kemeny G, Galletti G, Somarelli JA, Gupta S, Gregory SG, Scher HI, Dittamore R, Tagawa ST, Antonarakis ES, George DJ. Prospective Multicenter Validation of Androgen Receptor Splice Variant 7 and Hormone Therapy Resistance in High-Risk Castration-Resistant Prostate Cancer: The PROPHECY Study. J Clin Oncol. 2019 May 1;37(13):1120–1129.

Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

May 1, 2019

Volume

37

Issue

13

Start / End Page

1120 / 1129

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Reproducibility of Results
  • Receptors, Androgen
  • Protein Isoforms
  • Prostatic Neoplasms, Castration-Resistant
  • Prospective Studies
  • Progression-Free Survival
  • Predictive Value of Tests
  • Phenylthiohydantoin
  • Oncology & Carcinogenesis