Publication
Tumor clone dynamics in lethal prostate cancer
Journal Paper/Review - Sep 17, 2014
Carreira Suzanne, Demichelis Francesca, S de Bono Johann, Tunariu Nina, Flohr Penelope, Rodrigues Daniel Nava, Omlin Aurelius, Pezaro Carmel, Frenel Jean-Sebastien, Lorente David, Prandi Davide, Miranda Susana, Ferraldeschi Roberta, Grist Emily, Goodall Jane, Romanel Alessandro, Attard Gerhardt
Units
PubMed
Doi
Citation
Type
Journal
Publication Date
Issn Electronic
Pages
Brief description/objective
It is unclear whether a single clone metastasizes and remains dominant over the course of lethal prostate cancer. We describe the clonal architectural heterogeneity at different stages of disease progression by sequencing serial plasma and tumor samples from 16 ERG-positive patients. By characterizing the clonality of commonly occurring deletions at 21q22, 8p21, and 10q23, we identified multiple independent clones in metastatic disease that are differentially represented in tissue and circulation. To exemplify the clinical utility of our studies, we then showed a temporal association between clinical progression and emergence of androgen receptor (AR) mutations activated by glucocorticoids in about 20% of patients progressing on abiraterone and prednisolone or dexamethasone. Resistant clones showed a complex dynamic with temporal and spatial heterogeneity, suggesting distinct mechanisms of resistance at different sites that emerged and regressed depending on treatment selection pressure. This introduces a management paradigm requiring sequential monitoring of advanced prostate cancer patients with plasma and tumor biopsies to ensure early discontinuation of agents when they become potential disease drivers.