- Bertrand Tombal (Brussels, Belgium)
218MO - Comparison of a 22-gene genomic classifier (GC) with NCCN for risk stratification of Asian prostate cancers (PCa) (ID 1022)
- Woo Wai Yee (Singapore, Singapore)
Abstract
Background
Stratifying intermediate and high risk PCa is challenging due to the clinical heterogeneity of the disease. A 22-gene genomic classifier (GC) has demonstrated clinical utility in influencing treatment decisions in white and non-white men with PCa from Western cohorts. Here, we compared the GC with NCCN for risk stratification in an East-Asian PCa cohort.
Methods
GC (Decipher Biosciences, San Diego, CA) was performed on diagnostic biopsies or radical prostatectomy (RP) specimens in a pilot cohort (N=31). Gleason’s score (GS) and cellularity were reviewed by GU pathologist; RNA was extracted from 2 x 2.0-mm tumour cores using AllPrep DNA/RNA FFPE Kit and gene expression was performed on Affymetrix Decipher Biosciences array.
Results
One (3.2%), 6 (19.4%), 9 (29.0%) and 10 (32.3%) were defined as NCCN low- (LR), intermediate- (IR), high- (HR) and very high-risk (VHR), respectively; 5 (16.1%) presented with M1 at diagnosis. The 22-gene GC classified one (3.2%), 7 (22.6%) and 23 (74.2%) as LR (<0.45), IR (0.45-0.6) and HR (>0.6), [hp2] [AS3] respectively. All M1 PCa patients harbored high GC scores (range 0.796-0.955). Of the 9 NCCN HR patients, 5 (55.6%) were downgraded to GC-IR; while the VHR patients were not affected. For the 6 NCCN IR patients, 4 (66.7%) in fact harbored high GC scores (0.6336-0.7458). Variance in GC scores was highest in GS 6-7 tumors (GC range: 0.3594-0.7458). Using the six-tier combined NCCN-GC risk grouping (Spratt et al.), 4 (66.7%) and 1 (16.7%) of 6 IR patients were reclassified as HR and LR, respectively. 4 (44.4%) of 9 HR who were GC-IR were classified as NCCN-CG HR, but 5 (55.6%) patients who were GC-HR were upgraded to NCCN-CG VHR. Lastly, transcriptome profiling by PAM50 signature revealed a higher proportion of basal than luminal subtypes in our East-Asian cohort (25 [80.6%] vs 6 [19.4%]) and a low proportion of ETS+/ERG+/SPINK1+ PCa (4 [12.9%]).
Conclusions
Here, we present our preliminary data suggesting the utility of GC in precise risk stratification of Asian PCa patients. A follow-up study is warranted to investigate the accuracy of the NCCN-GC risk grouping in predicting survival and influencing treatment decision making in Asian men with PCa.
Legal entity responsible for the study
The authors.
Funding
National Medical Research Council (NMRC), Decipher Biosciences (Structured research agreement).
Disclosure
E. Davicioni: Leadership role, Full/Part-time employment, Chief Scientific Officer: Decipher Biosciences. M.L.K. Chua: Research grant/Funding (institution): Decipher BioSciences. All other authors have declared no conflicts of interest.
219MO - Real-world utilization pattern of bone-targeted agents for metastatic prostate cancer: Web-based questionnaire study by Hong Kong Society of Uro-Oncology (HKSUO) (ID 670)
- Darren M. Poon (Hong Kong, Hong Kong PRC)
Abstract
Background
Sufficient evidence and international guidelines support the use of Bone-Targeted Agents (BTA) in metastatic prostate cancer (mPC) in alleviating the risk of skeletal-related events (SREs) as a consequence of bone metastasis. However, BTA utilization pattern in Asian mPC patients remains undetermined. A survey was conducted to evaluate the current practice of BTA in Hong Kong.
Methods
This survey consisted of 20 questions with multiple choice answers, covering patient characteristics, practice preference and factors influencing the use of BTA for mPC. The survey was posted online and sent to HKSUO members, including oncologists and urologists in public and private sectors in Hong Kong. The survey was started since Jan 2020 and filled anonymously with password provided by HKSUO.
Results
30 clinicians (oncologists, 77%; urologists, 23%) completed the survey, with >50% practicing in public hospitals. Majority of the mPC patients had bone metastasis, with only 23% respondents reported <25% of their patients with bone metastasis. Diagnostic imaging for bone metastasis was considered for newly diagnosed prostate cancer when PSA level was high (57%), or patients presented with bone pain (34%). 74% of the respondents considered ≤1 week of waiting time for the imaging was optimal, however, only 40% of their patients has done so. BTA was considered as one of the treatment components (77%), with the primary goal for SRE prevention (73%). Clinicians tend to reserve BTA in patients with higher burden of bone metastasis (6-10 bone metastasis,27%; >10 bone metastasis, 40%). Efficacy (44%) and cost (33%) were the major considerations in selecting BTA. Denosumab was the preferred BTA (63%), while the average duration of treatment was >1 year (70%).
Conclusions
Our interim analysis shows BTA may be underutilized for Asian mPC patients in real-life setting. Approximately 1/4 of the respondents did not consider BTA in their treatment plan, albeit understanding its primary goal in SRE prevention. The misconception regarding the benefit of BTA limited in higher burden of disease may be the potential barriers. There seems to be an unmet need in the awareness of optimal use of BTA in mPC.
Legal entity responsible for the study
The authors.
Funding
Hong Kong Society of Uro-Oncology.
Disclosure
All authors have declared no conflicts of interest.
Invited Discussant abstracts 218MO and 219MO (ID 1093)
- Bertrand Tombal (Brussels, Belgium)
LIVE Q&A (ID 1094)
- Bertrand Tombal (Brussels, Belgium)
202MO - Real-world outcomes of non-clear cell renal cell carcinoma: Retrospective study from tertiary cancer center in India (ID 780)
- Amit K. Choudhary (Mumbai, India)
Abstract
Background
Non-clear cell renal cell carcinoma (nccRCC) represents a heterogenous group of RCC with limited representation in clinical trials due to their rarity and diverse histopathology. Thus, real-world data becomes important to give clue to the treating physicians for selecting the best possible treatment.
Methods
This is a retrospective, single center study to evaluate the outcomes of patients with nccRCC diagnosed and treated at Tata Memorial Center, Mumbai between 2017 and 2019. Baseline clinical features, histologic subtypes, therapeutic management and survival status were analyzed. SPPS version 20 was used for all statistical analyses.
Results
A total of 159 consecutive patients of nccRCC were evaluated for this study, 20 patients were excluded as these patients defaulted after their first visit. Out of 139 evaluable patients, 71.2% were males, the median age at diagnosis was 57 years (range: 10-81). Histologic subtypes comprised 76.2% papillary carcinoma, 6.5% sarcomatoid, 7.9% chromophobe, 1.4% unclassified tumors, and 0.7% oncocytoma. 51 (32%) patients were metastatic at presentation; 3 received supportive care alone due to poor performance status, 39.2% received sorafenib, sunitinib 27.4%, pazopanib 21.6% while bevacizumab erlotinib was given to 5.9% patients as first-line therapy. The median PFS of the overall patients was 6 months (95% CI: 2.4–9.6). The best response was partial response in 16.6%, stable disease 37.5%, and progressive disease in 45.8% of the patients. Only 21 (43.8%) could receive second-line therapy with everolimus being the most commonly used (38%). At the time of the data cut-off point (July 1, 2020), 29 metastatic patients had died, with a median overall survival of 11.9 months (95% CI: 5.4–18.4) with a median follow up of 14 months.
Conclusions
Papillary RCC comprised of the majority of the patients with nccRCC. This study reports worse survival outcomes as compared to other published studies. This might arise due to less use of subsequent lines of therapy and extremely low use of immunotherapy in the real-world scenario. Overall, the prognosis of nccRCC remains poor with a significant room for improvement.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
Invited Discussant abstracts 201MO and 202MO (ID 1095)
- Thomas B. Powles (London, United Kingdom)
LIVE Q&A (ID 1096)
- Bertrand Tombal (Brussels, Belgium)