genomic markers in prostate cancer decision making...oncotype dx 130 • vol. 18 no. 3 • 2016 •...

Genomic Markers in Prostate Cancer Decision

MakingRafael F. Coelho MD, PhD

Chief of Urologic Oncology - University of São Paulo, Brazil

Director of Prostate Cancer Department, Brazilian Society of Urology

Pre-treatment Risk stratification

biomarkers

Oncotype DX

Oncotype DX

Oncotype DX

Oncotype DX

Oncotype DX

Oncotype

Oncotype DX

130 • Vol. 18 No. 3 • 2016 • Reviews in Urology

Incorporation of the GenomicProstate Score (GPS) as part of thedecision algorithm for patients withvery low risk and low-risk cancer ledto substantial increase in uptake ofAS and substantial cost savings.

Prolaris

Prolaris

Prolaris

Prolaris

Prolaris

Prolaris

The CCP test has a significant impact in assistingphysicians and patients reach personalizedtreatment decisions

S0022-5347(15)04811-9 DOI: 10.1016/j.juro.2015.09.072

mean number of treatments per patient decreasing from 1.72 pre-CCP test to 1.16

Prolaris

Decipher

Decipher

Decipher

Decipher

Decipher

Cucchiara V, et al. Genomic Markers in Prostate Cancer Decision Making. Eur Urol(2017),

Pre-treatment Risk stratification biomarkers

Wagner J, et al "Prostate cancer genomics: Comparing Decipher, Prolaris, and Oncotype DX Results" AUA 2018; Abstract PD06-09.

A favorable prediction for each was defined as follows:

• Decipher and Prolaris: likelihood of 10 year PCM= 3%; • Oncotype DX: >70% likelihood of organ confined, Grade Group 1 or 2

Decipher – Prolaris agreement = 67%Prolaris – Oncotype =75%Decipher - Oncotype = 50%

Decipher – NCCN= 60%Prolaris – NCCN =75%Oncotype – NCCN = 50%

Vol. 199, No. 4S, Supplement, Friday, May 18, 2018

Notable differences exist in favorable prognostic outcomes obtainedfrom OncotypeDx, Prolaris, and Decipher. Prolaris is most apt toconfirm NCCN recommendation while Oncotype DX is more likely togo against it

Briganti et al. Eur Urol. 2018

Biological markers, appear promising to guide care of men with AS. However, they have not yet been prospectively robustly

tested in the AS setting. Therefore, while waiting for further data and even though some men may benefit for assessment of these

biomarkers, their use cannot be currently routinely recommended in AS.

Post-treatment Risk stratification

biomarkers

In patients treated with post-RP RT, GC is prognostic for the development of clinicalmetastasis beyond routine clinical and pathologic features. Pts with low GC scores are besttreated with salvage RT, whereas those with high GC scores benefit from adjuvant therapy

J Clin Oncol 33:944-951. © 2015

>0.4

23%

6%

In patients treated with post-RP RT, GC is prognostic for the development of clinicalmetastasis beyond routine clinical and pathologic features. Pts with low GC scores are besttreated with salvage RT, whereas those with high GC scores benefit from adjuvant therapy

J Clin Oncol 33:944-951. © 2015

Cancer August 1, 2017

Knowledge of Decipher test results was associated with treatment decision making and improved decisional effectiveness among men with PCa who were considering ART and SRT.

Adjuvant - 18% change

Salvage - 32% change

Prostate Cancer Biomarkers

Genomics in Michigan Impacting Observation or Radiation (G-MINOR)

NCT02783950

Number of participants that receive adjuvant therapy (radiation and/or hormone therapy)

Genomic make-up varies widely among CaP foci, so care should be takenwhen making treatment decisions based on a single biopsy or indexlesions

Eur Urol. 2017 February ; 71(2): 183–192