Barcelona, Spain (UroToday.com) In this talk, Dr. Mark Rubin provided a summary of genomic-based tests that are available and provided a framework for understanding how to interpret some of these results.
Sample acquisition for genomic testing can be done from multiple sites. For example, germline DNA can be obtained by cheek swab and can be used both for genetic testing for relevant mutations such as BRCA 1/2, or as a normal comparator for tumor genomic testing. Tumor samples can be obtained directly by biopsy or surgery and can be analyzed for changes in DNA and RNA that might predict response to therapies. Blood samples can also be obtained to assay germline DNA, as well as assay for certain DNA/RNA/protein features such as circulating tumor DNA or non-genomic measures such as metabolites.
The plethora of information from genomic testing is powerful, but can be anxiety-producing. Utilizing annotation tools or genomic databases can help put genomic information in context. Dr. Rubin provided the example of cBioPortal in his introductory talk for the session, and also discussed OncoKB which is a website that curates genomic alterations and describes the levels of evidence supporting their use in clinical decision making.
Finally, Dr. Rubin provided a list of some of the molecular tests or subtypes to know about that are either ready and approved, or seem to hold some promise for stratifying the care of prostate cancer patients. These are:
- Microsatellite instability testing – for immunotherapy response
- DNA damage repair status – for platinum therapy or PARP inhibitor
- AR alterations such as AR-V7 – for response to anti-androgens
- Circulating free DNA – for prognosis
- PTEN loss – possible biomarker for predicting response to AKT inhibitors
- CDK12 loss – immunotherapy response
- TP53/RB1 loss – shorter reponse to anti-androgen therapy, may predict platinum sensitivity
- Double negative (AR negative, non-neuroendocrine cells) – for response to FGFR inhibitors
- PSMA expression – response to PSMA conjugated radionuclide therapies
Presented by: Mark Rubin, MD, Professor and Director of the Department of Biomedical Research, University of Bern, Switzerland
Written by: Alok Tewari, MD, PhD, Medical Oncology Fellow at the Dana-Farber Cancer Institute, at the 2019 European Society for Medical Oncology annual meeting, ESMO 2019 #ESMO19, 27 Sept – 1 Oct 2019 in Barcelona, Spain