3266 - Genomic Tumor Testing in NCCN Favorable and Unfavorable Intermediate-Risk Prostate Cancer Informs Treatment Intensity: Data from an Open Access Research Registry

12:45pm - 02:00pm PT

Hall F

Screen: 16

POSTER

Presenter(s)

Christopher Lee, MD - Cancer Care Northwest, Spokane Valley, WA

C. M. Lee^1,2, W. Clegg³, O. K. Macdonald¹, B. J. Ager¹, J. A. Call Sr⁴, L. H. Lenz³, M. Schiewer³, R. Finch³, R. S. Lance⁵, C. D. Jacobs¹, and J. D. Tward⁶; ¹Cancer Care Northwest, Spokane, WA, ²Elson S. Floyd College of Medicine at Washington State University, Spokane, WA, ³Myriad Genetics, Inc., Salt Lake City, UT, ⁴Memorial Medical Center, Las Cruces, NM, ⁵Spokane Urology, Spokane, WA, ⁶Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT

Purpose/Objective(s):

Large real-world genetic and biomarker registries allow access to research on clinical/pathologic and genetic patient data. Creating patient-centric treatment plans for intermediate-risk prostate cancer patients in oncology can be challenging due to a variety of treatment options including: active surveillance (AS); single-modal therapy with surgery or radiation therapy (RT); or increased treatment intensity with multi-modal therapy (addition of androgen deprivation therapy [ADT] to RT). Using data from an open-access research registry, we describe the distribution of prostate cancer genomic biomarker test results in NCCN favorable intermediate- (FI) and unfavorable intermediate- (UFI) risk patients focusing on recommended treatment intensity with RT.

Materials/Methods:

The registry includes clinical pre-treatment and biomarker data from a 31-gene cell cycle progression test for 123,517 patients with prostate cancer. The test provides personalized risk estimates based on clinical and molecular features, including the 10-year risk of prostate-cancer specific mortality given conservative management, the 10-year risk of metastasis given single-modal therapy, and the absolute risk reduction of metastasis when ADT is added to RT. Based on these risk estimates, the test provides recommendation categories for patients as candidates for AS, single-modal therapy with RT, or multi-modal therapy with RT+ADT.

Results:

There were 118,404 patients with sufficient data for inclusion and 60,422 patients were FI- or UFI-risk. 31,935 patients were FI-risk patients; of these, 58.2% were recommended to de-intensify treatment and pursue AS, 41.5% to single-modal therapy, and <1% to intensify treatment to multi-modal therapy. Of the 28,487 UFI-risk patients, 11.9% were recommended to AS, 67.6% to single-modal therapy, and 20.5% to multi-modal therapy. The estimated 10-year risk of metastasis with single-modal therapy ranged from 0.2% to 26.5% in FI-risk patients and 0.2% to 66.7% in UFI-risk patients. The estimated absolute reduction in risk of 10-year metastasis ranged from 3.7% to 19.2% by adding ADT to RT for UFI-risk patients recommended for multi-modal therapy.

Conclusion:

Accurate risk classification and determination of absolute risk reduction are crucial to informing decisions about treatment intensity. As reflected in this database, the estimated 10-year risk of mortality and metastasis data for various treatment scenarios suggest that treatment can be de-intensified for many intermediate-risk prostate cancer patients. Access to large real-world clinical and genetic data registries allows for the study of patterns of clinical disease presentation, insights regarding personalized risk of oncologic outcomes, and facilitates future research focused on improving patient-centric care.