Decipher® Score: A Tool to Guide Treatment for Advanced Prostate Cancer
Currently, the standard of care treatment for metastatic hormone-sensitive prostate cancer (mHSPC) includes:
- Hormone therapy (ADT) + an androgen receptor pathway inhibitor (ARPI) such as enzalutamide or abiraterone
- ADT + the chemotherapy drug docetaxel
- ADT + ARPI + docetaxel
Which patients have more aggressive prostate cancer, and need more aggressive treatment? And which patients have cancer that is less likely to worsen, and can safely opt for less intense treatment, sparing their quality of life? These are key questions patients and doctors face.
The Decipher genomic classifier test looks at the activity of 22 genes in prostate tissue. A higher Decipher score indicates more aggressive disease. It is currently well-established in guiding treatment decisions in localized prostate cancer. Results presented at the European Society for Medical Oncology Congress in September showed that Decipher may be useful in informing treatment choice for patients with advanced disease (mHSPC) as well.
PCF Young Investigator Emily Grist, MBBS, PhD of the Cancer Institute at University College London discussed an analysis of STAMPEDE data. STAMPEDE is a large, long-term clinical trial testing multiple treatment approaches for mHSPC and high-risk localized prostate cancer. More than 1500 prostate tissue samples were analyzed. The team looked at the Decipher score for each patient and how it was related to survival and/or to response to treatment with the addition of abiraterone or docetaxel to ADT.
The results showed that:
- Patients with higher Decipher scores were more likely to die from prostate cancer. This was true for patients with mHSPC and for patients with non-metastatic high-risk localized prostate cancer
- Among patients with metastatic prostate cancer, those with higher Decipher scores were more likely to benefit from addition of docetaxel to ADT (vs. ADT alone)
- Patients treated with abiraterone + ADT lived longer vs. patients treated with ADT alone, regardless of Decipher score. In other words, according to this analysis, Decipher is not helpful in identifying patients who might benefit from addition of abiraterone to ADT
Dr. Grist concluded that the Decipher test is a rational tool to identify patients who may benefit from treatment intensification with docetaxel (vs. ADT alone). In the future, this test may inform treatment decisions for patients with advanced prostate cancer and their doctors.
Adapted from UroToday.com
Read more about promising treatment approaches from ESMO here.