AR-V7 in Peripheral Whole Blood of Patients with Castration-resistant Prostate Cancer: Association with Treatment-specific Outcome Under Abiraterone and Enzalutamide
2017
Abstract Background It has been demonstrated that androgen receptor splice variant 7 (AR-V7) expression in
circulating tumor cells(CTCs) predicts poor treatment response in metastatic castration-resistant prostate cancer (mCRPC) patients treated with
abirateroneor
enzalutamide. Objective To develop a practical and robust liquid profiling approach for direct quantification of AR-V7 in peripheral
whole bloodwithout the need for CTC capture and to determine its potential for predicting treatment response in mCRPC patients. Design, setting, and participants
Whole bloodsamples from a prospective
biorepositoryof 85 mCRPC patients before treatment initiation with
abiraterone( n =56) or
enzalutamide( n =29) were analyzed via droplet
digital polymerase chain reaction. Outcome measurements and statistical analysis The association of AR-V7 status with prostate-specific antigen (PSA) response defined by PSA decline ≥50% and with PSA–progression-free survival (PSA-PFS), clinical PFS, and overall survival (OS) was assessed. Results and limitations High AR-V7 expression levels in
whole bloodwere detectable in 18% (15/85) of patients. No patient with high AR-V7 expression achieved a PSA response, and AR-V7 status was an independent predictor of PSA response in multivariable logistic regression analysis ( p =0.03). High AR-V7 expression was associated with shorter PSA-PFS (median 2.4 vs 3.7 mo; p p p p p =0.02), and shorter OS (HR 3.0, 95% CI 1.4–6.3; p =0.005). Conclusions Testing of AR-V7 mRNA levels in
whole bloodis a simple and promising approach to predict poor treatment outcome in mCRPC patients receiving
abirateroneor
enzalutamide. Patient summary We established a method for determining AR-V7 status in
whole blood. This test predicted treatment resistance in patients with metastatic castration-resistant prostate cancer undergoing treatment with
abirateroneor
enzalutamide. Prospective validation is needed before application to clinical practice.
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