A CCR Score may offer a pathway without ADT in prostate cancer with a higher risk

A prognostic risk assessor incorporating genomic data and clinical factors may suggest the elimination of androgen deficiency therapy (ADT) in some men with moderate or high-risk prostate cancer after radiation therapy (RT), said a researcher.

In a retrospective confirmatory study involving nearly 750 men who received RT with a dose increase, those with a clinical cell cycle risk score (CCR) had a 10-year risk under a cut of 2.112 distant metastasis of just 4.1%, whatever. The National Cancer Comprehensive Network (NCCN) risk group reported that those above the threshold had a 10-year risk of 25.3%, said Jonathan Tward, MD, PhD, University of Utah in Salt Lake City.

In those with the lowest score, there were few differences based on receiving RT alone (4.2%), or RT plus ADT (3.9%), according to the results presented at the Virtual Genitourinary Cancer Symposium (GUCS).

Several studies have shown that ADT supplementation reduces the risk of metastasis in men with prostate cancer, Tward said. “Nevertheless, this clear friendly benefit may be clinically questionable when the baseline risk of metastasis in a population or any individual is low.”

Tward noted that approximately 70% of prostate cancer patients would fall below the threshold used in the study, meaning that half of men with moderate prostate cancer would be unfavorable, one in five of those with high-risk infection, and one in 20 with very high-risk ADT disease may be excluded.

CCR score combines the cell cycle progression (CCP) score, using the Prolaris test, with the UCSF Cancer of the Prostate Risk Assessment (CAPRA) score – which affects age, prostate specific antigen levels, score Gleason, T grade, and percentage of advanced corrections on biopsy.

Previous research had established a CCR score of 2.112 as a summary where men with moderate or high-risk prostate cancer received the least benefit from heterosexual therapies, but the study had some limitations, suggesting included RT dose and ADT duration were not accounted for. Also, different types of RT techniques were used and there were a small number of radiation subsets.

The routine diagnostic study addressed these issues and showed that CCR score was a better prognosticator of metastasis at 10 years compared to CAPRA or CCP-only scores:

• CCR: HR 2.21 (95% CI 1.70-2.87, C-index 0.78)

• CAPRA: HR 1.39 (95% CI 1.22-1.58, C-index 0.71)

• CCP: HR 2.04 (95% CI 1.48-2.79, C-index 0.69)

And CCR score was more accurate compared to NCCN risk subgroups (C-index 0.72). In all NCCN subgroups (intermediate favorable, unfavorable, high / very high), the risk of metastasis at 10 years was less than 5% when patients had a CCR score below incision.

“Adding ADT to RT adds unnecessary morbidity for very low risk reduction in metastasis-free survival for many in the moderately unfavorable risk and a significant minority of high-risk men,” Tward said. .

In EORTC 22991 for example, which was predominantly made up of men with non-smallpox and moderate risk, the overall risk of distant metastasis at 10 years fell from about 8% to 5% with ADT a more – leading to a number needed to treat about 30 people to prevent a single case of metastasis. A recent survey study suggested that most men would like an overall risk reduction in metastatic disease of 5% to consider ADT over RT alone, Tward said.

GUCS debater Richard Valicenti, MD, of UC Davis School of Medicine, warned that a biomarker has not been pre-tested and has been shown to improve long-term outcomes in men with higher-risk prostate cancer.

“Clearly, the CCR score may provide highly accurate personalized estimates and justify testing in nonviolence studies with appropriate potency and power, according to NCCN risk groups,” he said. studies such as this establish a fully integrated approach to the treatment of prostate cancer based on a multilevel multidisciplinary strategy. “

He identified the NRG-GU009 test, which is currently underway and will test such a personalized decentralization method for men with high-risk prostate cancer using the Decomher genomic risk classification.

The current study examined the CCR score in 741 assessed patients with biopsy–mediated prostate cancer (70%) or high-risk cancer (30%) based on NCCN criteria. Tward and colleagues underwent a biopsy strain and performed genetic testing afterwards, years after patient treatment, eliminating the risk of bias in treatment decisions. The median follow-up was 5.9 years.

Patients were admitted if they had received external beam radiation treatment using modern methods and modern dose radiation (≥75.6 Gy at 1.8 Gy per fraction) with treatment design based on CT. Those receiving pelvic nodal radiotherapy were licensed. The use and duration of ADT had to be captured.

Approximately half of the patients were treated with ADT in combination with RT. In men with unfavorable intermediate risk cancer, the duration of ADT was considered “sufficient” if they received at least 4 months of ADT, and at least 18 months for men with high-risk cancer – a match NCCN standard guidance recommendations. Less than half (44%) received some ADT but not enough, according to this criterion.