Faster genomic sequencing and other tools are hastening the development of new diagnostic and prognostic tools for prostate cancer. Yet determining how best to develop, translate, and deploy them to the clinic will be a methodical process, reported researchers at the 2018 Genitourinary (GU) Cancers Symposium in San Francisco, California.

“With an improving understanding of the frequency and clinical impact of molecular alterations in advanced disease, there are emerging prognostic and predictive genomic biomarkers that may be useful in the clinic,” said Himisha Beltran, MD, associate professor of medicine at Weill Cornell Medical College and director of clinical and translational research of the Englander Institute for Precision Medicine in New York, New York. Dr Beltran co-chaired a February 8 panel discussion on emerging diagnostics and therapies in advanced prostate cancer at the GU Symposium.

This session focused on translating emerging biologic observations into the clinic and covered a range of “hot topics” including the role of immunotherapy, management of oligometastatic disease, genomics and precision oncology, and advances in bone-targeted therapies, Dr Beltran told Cancer Therapy Advisor ahead of the panel discussion.

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Prostate Cells Mimic Bone

Advances in understanding of the molecular mechanisms involved in treatment response might open up new ways to select patients for particular treatments and to develop new treatment strategies.

For example, radium-223, a bone-targeting alpha particle emitter, improves survival among men with metastatic castration resistant prostate cancer (mCRPC). But the molecular basis for that benefit has remained a largely open question.

Part of the answer to that question, it turns out, might be that prostate cancer cells frequently evolve to mimic bone tissue, which can facilitate the uptake of radium-223 by bone-dwelling prostate tumor metastases, according to the authors of a study conducted at the Duke Cancer Institute in Durham, North Carolina, which was presented during the Symposium panel session.1

The study included 20 patients with heavily pretreated and symptomatic bone mCRPC who were treated with radium-223 for a median of 6 doses. The investigators identified circulating tumor cells (CTCs) in many patients with evidence of osteomimicry.