Department of Urology, Nippon Medical School.
Pathology Informatics Team, RIKEN Center for Advanced Intelligence Project.
J Nippon Med Sch. 2024;91(5):472-479. doi: 10.1272/jnms.JNMS.2024_91-512.
Several effective treatment modalities against metastatic castration-resistant prostate cancer (mCRPC) are available; however, an unmet clinical need persists for mCRPC treatment because resistance to these therapies is inevitable. This study aimed to evaluate the status of comprehensive genomic profiling (CGP) and its impact on subsequent treatments for patients with mCRPC at our hospital.
Between December 2020 and August 2023, we assessed 41 patients with mCRPC who underwent CGP testing at the Nippon Medical School Hospital. The testing comprised FoundationOne CDx for 30 patients and FoundationOne Liquid CDx for 11 patients, following the procedures outlined by the Japanese Urological Association.
CGP testing was successfully conducted in 40 out of 41 patients (97.6%), which resulted in the identification of 140 actionable genomic alterations. The most common alteration was TP53 in 12 patients (30.0%). Twenty-three patients (57.5%) with druggable gene alterations were identified; 21 were recommended for clinical trials, four for patient-proposed healthcare services, and six for insurance-covered drugs. Consequently, genotype-matched therapy with insurance-covered drugs was administered to five patients (12.5%) with a BRCA2 mutation. Notably, none of the patients underwent clinical or prospective trials based on patient-suggested medical services.
Our results offer insights into the real-world application of CGP testing for patients with mCRPC at a cooperative hospital for cancer genomic medicine in Japan. Thus, urologists require a comprehensive understanding of the current status of CGP testing to enhance mCRPC management.
有几种有效的治疗转移性去势抵抗性前列腺癌（mCRPC）的方法，但由于这些治疗方法不可避免地会产生耐药性，因此 mCRPC 的治疗仍存在未满足的临床需求。本研究旨在评估我院 mCRPC 患者综合基因组分析（CGP）的现状及其对后续治疗的影响。
在 2020 年 12 月至 2023 年 8 月期间，我们评估了在日本顺天堂医院接受 CGP 检测的 41 例 mCRPC 患者。该检测包括 30 例患者使用 FoundationOne CDx 和 11 例患者使用 FoundationOne Liquid CDx，均按照日本泌尿科协会规定的程序进行。
41 例患者中有 40 例（97.6%）成功进行了 CGP 检测，共发现 140 种可靶向基因组改变。最常见的改变是 12 例患者的 TP53（30.0%）。23 例（57.5%）有可用药基因改变的患者被识别；21 例建议参加临床试验，4 例建议患者提出的医疗服务，6 例建议保险覆盖药物。因此，有 5 例 BRCA2 突变患者接受了与基因型匹配的保险覆盖药物治疗。值得注意的是，没有患者根据患者建议的医疗服务参加临床或前瞻性试验。
我们的结果提供了日本癌症基因组医学合作医院 mCRPC 患者 CGP 检测实际应用的见解。因此，泌尿科医生需要全面了解 CGP 检测的现状，以加强 mCRPC 的管理。
