Cargando…

Impact of a genomic classifier of metastatic risk on postoperative treatment recommendations for prostate cancer patients: a report from the DECIDE study group

BACKGROUND: Only a minority of prostate cancer patients with adverse pathology and biochemical recurrence (BCR) post radical prostatectomy (RP) experience metastasis and die from prostate cancer. Improved risk prediction models using genomic information may enable clinicians to better weigh the risk...

Descripción completa

Detalles Bibliográficos
Autores principales: Badani, Ketan, Thompson, Darby J. S., Buerki, Christine, Davicioni, Elai, Garrison, Jill, Ghadessi, Mercedeh, Mitra, Anirban P., Wood, Penelope J., Hornberger, John
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Impact Journals LLC 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3720607/
https://www.ncbi.nlm.nih.gov/pubmed/23592338
_version_ 1782277973690286080
author Badani, Ketan
Thompson, Darby J. S.
Buerki, Christine
Davicioni, Elai
Garrison, Jill
Ghadessi, Mercedeh
Mitra, Anirban P.
Wood, Penelope J.
Hornberger, John
author_facet Badani, Ketan
Thompson, Darby J. S.
Buerki, Christine
Davicioni, Elai
Garrison, Jill
Ghadessi, Mercedeh
Mitra, Anirban P.
Wood, Penelope J.
Hornberger, John
author_sort Badani, Ketan
collection PubMed
description BACKGROUND: Only a minority of prostate cancer patients with adverse pathology and biochemical recurrence (BCR) post radical prostatectomy (RP) experience metastasis and die from prostate cancer. Improved risk prediction models using genomic information may enable clinicians to better weigh the risk of metastasis and the morbidity and costs of treatment in a clinically heterogeneous population. PURPOSE: We present a clinical utility study that evaluates the influence on urologist treatment recommendations for patients at risk of metastasis using a genomic-based prediction model (Decipher(TM)). METHODS: A prospective, pre-post design was used to assess urologist treatment recommendations following RP in both the adjuvant (without any evidence of PSA rise) and salvage (BCR) settings. Urologists were presented de-identified pathology reports and genomic classifier (GC) test results for 24 patients from a previously conducted GC validation study in high-risk post-RP men. Participants were fellowship trained, high-volume urologic oncologists (n=21) from 18 US institutions. Treatment recommendations for secondary therapy were made based solely on clinical information (pre-GC) and then with genomic biomarker information (post-GC). This study was approved by an independent IRB. RESULTS: Treatment recommendations changed from pre-GC to post-GC in 43% of adjuvant, and in 53% of salvage setting case evaluations. In the adjuvant setting, urologists changed their treatment recommendations from treatment (i.e. radiation and/or hormones) to close observation post-GC in 27% of cases. For cases with low GC risk (<3% risk of metastasis), observation was recommended for 79% of the case evaluations post-GC. Consistent trends were observed in the salvage setting. CONCLUSION: These results indicate that urologists across a range of practice settings are likely to change treatment decisions when presented with genomic biomarker information following RP. Implementation of genomic risk stratification into routine clinical practice may better direct treatment decision-making post-RP.
format Online
Article
Text
id pubmed-3720607
institution National Center for Biotechnology Information
language English
publishDate 2013
publisher Impact Journals LLC
record_format MEDLINE/PubMed
spelling pubmed-37206072013-07-30 Impact of a genomic classifier of metastatic risk on postoperative treatment recommendations for prostate cancer patients: a report from the DECIDE study group Badani, Ketan Thompson, Darby J. S. Buerki, Christine Davicioni, Elai Garrison, Jill Ghadessi, Mercedeh Mitra, Anirban P. Wood, Penelope J. Hornberger, John Oncotarget Research Paper BACKGROUND: Only a minority of prostate cancer patients with adverse pathology and biochemical recurrence (BCR) post radical prostatectomy (RP) experience metastasis and die from prostate cancer. Improved risk prediction models using genomic information may enable clinicians to better weigh the risk of metastasis and the morbidity and costs of treatment in a clinically heterogeneous population. PURPOSE: We present a clinical utility study that evaluates the influence on urologist treatment recommendations for patients at risk of metastasis using a genomic-based prediction model (Decipher(TM)). METHODS: A prospective, pre-post design was used to assess urologist treatment recommendations following RP in both the adjuvant (without any evidence of PSA rise) and salvage (BCR) settings. Urologists were presented de-identified pathology reports and genomic classifier (GC) test results for 24 patients from a previously conducted GC validation study in high-risk post-RP men. Participants were fellowship trained, high-volume urologic oncologists (n=21) from 18 US institutions. Treatment recommendations for secondary therapy were made based solely on clinical information (pre-GC) and then with genomic biomarker information (post-GC). This study was approved by an independent IRB. RESULTS: Treatment recommendations changed from pre-GC to post-GC in 43% of adjuvant, and in 53% of salvage setting case evaluations. In the adjuvant setting, urologists changed their treatment recommendations from treatment (i.e. radiation and/or hormones) to close observation post-GC in 27% of cases. For cases with low GC risk (<3% risk of metastasis), observation was recommended for 79% of the case evaluations post-GC. Consistent trends were observed in the salvage setting. CONCLUSION: These results indicate that urologists across a range of practice settings are likely to change treatment decisions when presented with genomic biomarker information following RP. Implementation of genomic risk stratification into routine clinical practice may better direct treatment decision-making post-RP. Impact Journals LLC 2013-09-08 /pmc/articles/PMC3720607/ /pubmed/23592338 Text en Copyright: © 2013 Badani et al. http://creativecommons.org/licenses/by/2.5/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
spellingShingle Research Paper
Badani, Ketan
Thompson, Darby J. S.
Buerki, Christine
Davicioni, Elai
Garrison, Jill
Ghadessi, Mercedeh
Mitra, Anirban P.
Wood, Penelope J.
Hornberger, John
Impact of a genomic classifier of metastatic risk on postoperative treatment recommendations for prostate cancer patients: a report from the DECIDE study group
title Impact of a genomic classifier of metastatic risk on postoperative treatment recommendations for prostate cancer patients: a report from the DECIDE study group
title_full Impact of a genomic classifier of metastatic risk on postoperative treatment recommendations for prostate cancer patients: a report from the DECIDE study group
title_fullStr Impact of a genomic classifier of metastatic risk on postoperative treatment recommendations for prostate cancer patients: a report from the DECIDE study group
title_full_unstemmed Impact of a genomic classifier of metastatic risk on postoperative treatment recommendations for prostate cancer patients: a report from the DECIDE study group
title_short Impact of a genomic classifier of metastatic risk on postoperative treatment recommendations for prostate cancer patients: a report from the DECIDE study group
title_sort impact of a genomic classifier of metastatic risk on postoperative treatment recommendations for prostate cancer patients: a report from the decide study group
topic Research Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3720607/
https://www.ncbi.nlm.nih.gov/pubmed/23592338
work_keys_str_mv AT badaniketan impactofagenomicclassifierofmetastaticriskonpostoperativetreatmentrecommendationsforprostatecancerpatientsareportfromthedecidestudygroup
AT thompsondarbyjs impactofagenomicclassifierofmetastaticriskonpostoperativetreatmentrecommendationsforprostatecancerpatientsareportfromthedecidestudygroup
AT buerkichristine impactofagenomicclassifierofmetastaticriskonpostoperativetreatmentrecommendationsforprostatecancerpatientsareportfromthedecidestudygroup
AT davicionielai impactofagenomicclassifierofmetastaticriskonpostoperativetreatmentrecommendationsforprostatecancerpatientsareportfromthedecidestudygroup
AT garrisonjill impactofagenomicclassifierofmetastaticriskonpostoperativetreatmentrecommendationsforprostatecancerpatientsareportfromthedecidestudygroup
AT ghadessimercedeh impactofagenomicclassifierofmetastaticriskonpostoperativetreatmentrecommendationsforprostatecancerpatientsareportfromthedecidestudygroup
AT mitraanirbanp impactofagenomicclassifierofmetastaticriskonpostoperativetreatmentrecommendationsforprostatecancerpatientsareportfromthedecidestudygroup
AT woodpenelopej impactofagenomicclassifierofmetastaticriskonpostoperativetreatmentrecommendationsforprostatecancerpatientsareportfromthedecidestudygroup
AT hornbergerjohn impactofagenomicclassifierofmetastaticriskonpostoperativetreatmentrecommendationsforprostatecancerpatientsareportfromthedecidestudygroup