Decipher score is predictive for docetaxel-benefit in mestastatic prostate cancer

Data from the STAMPEDE trial showed that the Decipher classifier was able to predict which patients with metastatic prostate cancer benefit from adding docetaxel to androgen deprivation therapy (ADT) plus an androgen receptor pathway inhibitor (ARPI).

The current standard-of-care for men with metastatic prostate cancer is ADT plus an ARPI [1]. Adding docetaxel to ADT can improve survival for some men but comes with a cost to quality-of-life [2]. Therefore, a predictive test that evaluates whose cancer is docetaxel-sensitive would improve clinical decision-making.

The Decipher classifier is based on the expression of 22 mRNAs and is designed to identify the biological state associated with metastasis, and it is prognostic in localised disease [3]. Using data from 1,523 participants enrolled in the STAMPEDE trial (NCT00268476), Dr Emily Grist (University College London, UK) and colleagues tested whether the Decipher score is prognostic and/or predictive for docetaxel benefit [4].

Decipher score (high vs lower) was predictive of the benefit of adding docetaxel to ADT in patients with metastatic prostate cancer: HR 0.64 (95% CI 0.48–0.86) in Decipher-high versus HR 0.96 (95% CI 0.71–1.3) in Decipher-lower. This effect was also seen in subgroups with low-volume and high-volume metastatic prostate cancer (see Figure).

Figure: Decipher score to predict treatment effect in patients with high-volume metastatic prostate cancer [4]



“So, the Decipher classifier provides a rational biomarker for the selection of patients who will benefit from ADT plus ARPI plus docetaxel,” Dr Grist concluded.

1. Fizazi K, et al. N Engl J Med 2017;377:352-360.
2. Rush HL, et al. J Clin Oncol. 2022;10; 40:825-836.
3. Nguyen PL, et al. Int J Radiat Oncol Biol Phys. 2023;116:521-529.
4. Grist E, et al. Decipher mRNA score for prediction of survival benefit from docetaxel at start of androgen deprivation therapy (ADT) for advanced prostate cancer (PC): An ancillary study of the STAMPEDE docetaxel trials. Abstract 1596O, ESMO Congress 2024, 13–17 September, Barcelona, Spain.

 

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Posted on 4 November 20244 November 2024