Abstract
Multiple treatment options with different mechanisms of action are currently available for the management of metastatic prostate cancer. However, the optimal use of these therapies-specifically, the sequencing of therapies-is not well defined. In order to obtain the best clinical outcomes, patients need to be treated with the therapies that are most likely to provide benefit and avoid toxic therapies that are unlikely to be effective. Ideally, predictive biomarkers that allow for the selection of the therapies most likely to be of benefit would be employed for each treatment decision. In practice, biomarkers including tumor molecular sequencing, circulating tumor DNA, circulating tumor cell enumeration and androgen receptor characteristics, and tumor cell surface expression (PSMA), all may have a role in therapy selection. In this review, we define the established prognostic and predictive biomarkers for therapy in advanced prostate cancer and explore emerging biomarkers.
Highlights
Prostate cancer is the most common malignancy among males in United States, with an incidence rate of 111.3 per 100,000 men per year (2014–2018) [1]
Patients with androgen receptor (AR)-V7 mRNA detected in circulating tumor cells (CTCs) derive greater survival benefit, both in terms of overall survival and progression free survival with taxane therapy, compared to those with abiraterone or enzalutamide [74,92]
This study suggests that PDL1 greater or equal to 1%, Homologous recombination repair (HRR) deficiency, mutations in deoxyribonucleic acid (DNA) damage repair genes, and high Tumor mutational burden (TMB) may all predict response to Immune checkpoint inhibitors (ICI) in metastatic castration-resistant prostate cancer (mCRPC) [102,103]
Summary
Prostate cancer is the most common malignancy among males in United States, with an incidence rate of 111.3 per 100,000 men per year (2014–2018) [1]. With the incorporation of personalized medicine and genomic sequencing in the management of prostate cancer, targetable molecular alterations were identified, as well as mechanisms of resistance that can be used to determine which available treatment is likely to be most clinically advantageous for a patient [5]. We review both established and novel biomarkers for treatment response in advanced prostate cancer
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