Identification of mechanisms of resistance to treatment with abiraterone acetate or enzalutamide in patients with castration-resistant prostate cancer (CRPC)
2018
BACKGROUND Two androgen receptor (AR)-targeted therapies,
enzalutamideand
abiraterone acetateplus prednisone (
abiraterone), have been approved for the treatment of metastatic castration-resistant prostate cancer (CRPC). Many patients respond to these agents, but both de novo and acquired resistance are common. The authors characterized resistant phenotypes that emerge after treatment with
abirateroneor
enzalutamide. METHODS Patients who received
abirateroneor
enzalutamidein the course of routine clinical care were consented for serial blood collection. A proprietary system (CellSearch) was used to enumerate and enrich
circulating tumor cells(CTCs). RNA-sequencing (
RNA-seq) was performed on pools of up to 10
epithelial cell adhesion molecule(EpCAM)-positive/CD45-negative CTCs. The impact of gene expression changes observed in CTCs between patients who responded or were resistant to
abiraterone/
enzalutamidetherapies was further explored in a model cell line system. RESULTS
RNA-seqdata from CTCs identified mutations commonly associated with CRPC as well as novel mutations, including several in the ligand-binding domain of AR that could facilitate escape from AR-targeted agents.
Ingenuity
pathway analysisof differentially regulated genes identified the transforming growth factor β (TGFβ) and cyclin D1 (CCND1) signaling pathways as significantly upregulated in drug-resistant CTCs. Transfection experiments using
enzalutamide-sensitive and
enzalutamide-resistant
LNCaPcells confirmed the involvement of
SMADfamily member 3, a key mediator of the TGFβ pathway, and of CCND1 in resistance to
enzalutamidetreatment. CONCLUSIONS The current results indicate that
RNA-seqof CTCs representing
abirateroneand
enzalutamidesensitive and resistant states can identify potential mechanisms of resistance. Therapies targeting the downstream signaling mediated by
SMADfamily member 3 (SMAD3) and CCND1, such as
cyclin-dependent kinase 4/
cyclin-dependent kinase 6inhibitors, could provide new therapeutic options for the treatment of
antiandrogen-resistant disease. Cancer 2017. © 2017 American Cancer Society.
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