News | Prostate Cancer | February 29, 2016

Precision Oncology Could Be Tailor-made for Metastatic Prostate Cancer

Study finds tissue from a single metastasis could provide all the information needed to custom-design therapy for patients with advanced prostate cancer

metastatic prostate cancer, precision oncology, Fred Hutchinson Cancer Research Center study

February 29, 2016 — Metastatic prostate cancer, where better therapeutic strategies are desperately needed, appears to be tailor-made for precision oncology, according to a new study by researchers at Fred Hutchinson Cancer Research Center in Seattle. They found that a single metastasis within an individual patient can provide consistent molecular information to help guide therapy in metastatic prostate cancer.

The research showed that though they are very complex, prostate cancer metastases within an individual patient are strikingly similar in their molecular characteristics, while metastases from different patients have very dissimilar characteristics. This suggests that patients could benefit from individualized therapy and that a single biopsy will likely provide enough information to guide that therapy.

Evidence has been growing that molecular characteristics of original or primary tumors, which often take decades to develop, can exhibit substantial heterogeneity, or variation in the composition of cancer-causing genes in different areas within the tumors. In contrast, scientists have little information about the diversity to be found in metastases, the tumors that arise from cells that have broken free and traveled far from the first tumor. When cancer spreads, it often relocates to several distant sites within an individual, leading to the question of whether obtaining a sample of one metastatic site would provide information that is relevant for guiding therapy of the other sites of spread. Uniformity among metastases within a patient would ensure that therapies designed to target a specific metastasis would likely treat all of a patient’s metastases.

To work effectively, precision oncology requires two things: that tumors from different individuals are very different in their oncogenic drives and therapeutic susceptibilities, and that tumors within an individual are quite uniform. This means that researchers can develop a therapy that can effectively target all of a specific patient’s tumors, even if it is not effective for other patients.

Primary tumors, which can be very heterogeneous, can be managed by surgery or radiation. There are few effective treatments for metastatic cancer. Patients with metastatic disease need different interventions — but these will only work if the metastases are not heterogeneous. Peter S. Nelson, M.D., a member of the Human Biology, Clinical Research and Public Health Sciences divisions at Fred Hutch, and his team set out to determine whether prostate cancer metastases meet the conditions for effective precision oncology: homogeneous within patients, but heterogeneous between patients.

Primary or metastatic tumors from 176 men were removed and analyzed for various genetic and genomic alterations, such as copy number alterations, gene expression and whole-exome sequencing. (Not all tumors were assessed all three ways.)

The researchers found limited genomic diversity within patients, meaning that a single metastasis provided complete molecular and genetic information. The presumptive driver mutations generally occurred within all metastases tested from a single individual. The mutations that were found to be unique to specific tumors were generally not predicted to be detrimental. Substantial differences in genomic alterations were found between individuals.

“If you look in multiple metastases within a given patient, they’re actually very, very similar,” said Nelson, the study’s senior and corresponding author. “They’re not identical, but in terms of the key features of a cancer that would inform how best to treat that cancer we can feel generally confident, at least with prostate carcinoma, that if you did sample a single tumor, you could make clinical decisions based on what you find.”

The insights of the study were not used to guide therapy, only to suggest that this strategy looks promising.

The work was funded by the National Institutes of Health (Pacific Northwest Prostate Cancer SPORE grant), the U.S. Department of Defense, a Fred Hutchinson Cancer Research Center Solid Tumor Translational Research Award and the Prostate Cancer Foundation. The authors declare no competing financial interests.

For more information: www.nature.com/nm

Related Content

Stronger Distribution Networks to Bolster Radiotherapy Patient Positioning Accessories
News | Patient Positioning Radiation Therapy | July 19, 2019
A recent study projects global market revenues for radiotherapy patient positioning accessories will exceed revenues of...
IBM collected a dataset of 52,936 images from 13,234 women who underwent at least one mammogram between 2013 and 2017.

IBM collected a dataset of 52,936 images from 13,234 women who underwent at least one mammogram between 2013 and 2017, and who had health records for at least one year prior to the mammogram. The algorithm was trained on 9,611 mammograms. Image courtesy of Radiology.

Feature | Artificial Intelligence | July 19, 2019 | Michal Chorev
Breast cancer is the global leading cause of cancer-related deaths in women, and the most commonly diagnosed cancer...
CMS Proposes New Alternative Payment Model for Radiation Oncology
News | Radiation Oncology | July 17, 2019
The Centers for Medicare and Medicaid Services (CMS) issued a proposal for an advanced alternative payment model (APM)...
AAPM 2019 Features More Than 40 Presentations on ViewRay's MRIdian MRI-guided Radiotherapy
News | Image Guided Radiation Therapy (IGRT) | July 16, 2019
ViewRay Inc. announced that the company's MRIdian System is the focus of more than 40 abstracts selected by the...
RaySearch Releases Version 3A of RayCare Oncology Information System
Technology | Oncology Information Management Systems (OIMS) | July 15, 2019
RaySearch has released RayCare 3A, a new version of the next-generation oncology information system (OIS). RayCare is...
IBA Launches Monte Carlo Patient QA for Varian Halcyon at AAPM 2019
Technology | Quality Assurance (QA) | July 10, 2019
IBA announced the launch of the latest functionality of the SciMoCa Monte Carlo Patient QA solution at the 61st annual...
Researchers Use Artificial Intelligence to Deliver Personalized Radiation Therapy
News | Radiation Therapy | July 09, 2019
New Cleveland Clinic-led research shows that artificial intelligence (AI) can use medical scans and health records to...
The Beamscan 3-D water phantom with the Varian Halcyon radiotherapy system

The Beamscan 3-D water phantom with the Varian Halcyon radiotherapy system. Image courtesy of PTW.

News | Quality Assurance (QA) | July 08, 2019
At this year’s American Association of Physicists in Medicine (AAPM) show, July 14-18 in San Antonio, Texas, PTW will...
Aktina Medical Partners With Elekta for Global Distribution of Interlocking SRS Cones
News | Radiation Therapy | July 05, 2019
Aktina Medical announced that Elekta Instrument AB, based in Sweden, will offer and distribute the Aktina line of...