Scientists from the Spanish National Cancer Research Centre (CNIO) in Madrid, along with British colleagues from the Institute for Cancer Research (ICR) and the Royal Marsden NHS Foundation Trust, have developed a test that studies genetic patterns in blood cells to detect advanced–stage prostate cancer. The results of the study are being published today in the journal The Lancet Oncology.
The study shows that gene patterns in blood cells act as a barcode and could be used together with the current PSA test to select those patients with the worst prognosis in need of immediate treatment.
Advanced stage prostate cancer is a very heterogeneous illness in its symptomatology and evolution. Some patients live with it for several years without showing any symptoms, whilst in other cases the tumour can be very aggressive and deadly. This heterogeneity highlights the need to develop reliable tests that discriminate between the different types of patients.
In this study, led by David Olmos from Málaga and Johann de Bono from ICR and The Royal Marsden, the researchers demonstrate that the signs prostate cancer leaves in the blood can be used to further understand the illness. David Olmos has just joined CNIO to set up the Prostate Cancer Clinical Research Unit.
The study described in the article consists of sampling the genetic changes in the patient's blood. These changes can be interpreted as barcodes to identify those patients who are going to suffer an aggressive form of the cancer. Using the results, doctors could adjust treatment to the specific profile of each patient.
In order to carry out the study, the scientists scanned all the genes in the blood samples of 100 patients with prostate cancer; 69 patients were suffering from an advanced stage of prostate cancer and 31 patients has a localised, low-risk tumour.
Using statistical models, the researchers split the patients into four groups that reflected the different genetic activity patterns—what we have described above as barcodes. After following the patients for approximately two-and-a-half years, the authors observed that one of these groups of patients had a much lower survival rate.
This group had a barcode that can be summed up as showing alterations in the activity of nine genes, and an alteration in the different functions of the immunological system, which suggests that the cancerous cells unleash an anomalous immune response as they multiply in the body.
The authors of the study confirmed these results with 70 additional patients from the Memorial Sloan Kettering Cancer Centre in New York who were also suffering from advanced stage prostate cancer. These results show that this nine-gene barcode can be useful and precise in identifying those patients with the worst prognosis.
"The test we have developed is simpler and potentially more precise than many other tests we currently have available or than carrying out another biopsy", say the researchers in their study.
The authors of this study plan to evaluate this new test in large-scale clinical trial that will analyse the efficiency of a new drug for treating prostate cancer. Other studies, led by CNIO researchers, will also analyse the utility of these blood tests in patients at early stages of the illness.
David Olmos, the study's lead researcher, joined CNIO last September to head CNIO's Prostate Cancer Clinical Research Unit. Olmos previously worked at the Institute for Cancer Research (ICR) and The Royal Marsden NHS Foundation Trust in London, where the study was carried out. David Olmos has made very important contributions to the study of prostate cancer, working with the development of new biomarkers for tracking the illness and the development of phase I, II and III clinical trials for new drugs, some of which have recently been approved for treating the illness.
About CNIO's Prostate Cancer Clinical Research Unit
One of the first goals of CNIO's Prostate Cancer Clinical Research Unit, created in September 2012, is to bring a multi-disciplinary focus that brings together the work of molecular biologists, bioinformatics engineers and clinical oncologists. The creation of this new unit represents an investment by CNIO in improving the quality of life and survival of patients with the illness, which is the third cause of death among Spanish males, resulting in almost 6,000 fatalities each year. This multidisciplinary approach means to accelerate the translation of new knowledge generated at CNIO to clinical practitioners and the international scientific community so both healthcare professionals and patients with prostate cancer may further benefit.
This new unit is added to the five that already form part of CNIO's Clinical Research Programme, directed by Manuel Hidalgo, the Vice-President of Translational Research, in which clinical and basic researchers work together to discover new solutions for patients with tumours of the digestive system and breast cancer.
Reference article:
Prognostic value of blood mRNA expression signatures in castration-resistant prostate cancer: a prospective, two-stage study. David Olmos, Daniel Brewer, Jeremy Clark, Daniel C Danila, Chris Parker, Gerhardt Attard, Martin Fleischer, Alison H M Reid, Elena Castro, Shahneen K Sandhu, Lorraine Barwell, Nikhil Babu Oommen, Suzanne Carreira, Charles G Drake, Robert Jones, Colin S Cooper, Howard I Scher, Johann S de Bono. The Lancet Oncology (2012). doi: S1470-2045(12)70372-8
Journal
The Lancet Oncology