Abstract
Background
CALGB 90401 (Alliance) was a phase III trial of 1050 patients with metastatic castration-resistant prostate cancer (mCRPC) comparing docetaxel, prednisone, bevacizumab (DP+B) versus DP alone. While this trial did not show an improvement in overall survival (OS), there were improved intermediate outcomes suggesting that subsets of men may derive benefit from this combination. The purpose of this analysis was to identify prognostic and predictive biomarkers associated with OS and progression-free survival (PFS) benefit from DP+B.
Methods
Baseline EDTA plasma samples from 650 consenting patients were analyzed for 24 biomarkers. The proportional hazards model was utilized to test for the prognostic and predictive importance of the biomarkers for OS. The statistically significant biomarkers of OS were further investigated for prognostic and predictive importance for other secondary outcomes.
Results
15 markers [ICAM-1, VEGF-R3, TIMP-1, TSP-2, Ang-2, Her-3, Osteopontin (OPN), PlGF, VCAM-1, HGF, VEGF, Chromogranin A, IL-6, VEGF-R1, BMP-9] were prognostic of OS, while 9 markers (ICAM-1, VEGF-R3, Her-3, TIMP-1, Ang-2, OPN, PlGF, HGF, and VEGF) were also prognostic of PFS. All markers were statistically significant in univariate analyses after adjustment for multiplicity (FDR < 0.1). In multivariable analyses of OS adjusting for risk score, seven markers had FDR < 0.1, including ICAM-1, VEGF-R3, TIMP-1, Ang-2, VEGF, TSP-2 and HGF. In unadjusted analysis, OPN was predictive of PFS improvement with DP+B, in both univariate and multivariable analysis. However, none of the biomarkers tested were predictive of clinical outcomes after adjusting for multiple comparisons.
Conclusions
Multiple biomarkers were identified in CALGB 90401 as prognostic of clinical outcomes but not predictive of OS. While OPN may have promise as a potential biomarker for anti-angiogenic therapies, further mechanistic and clinical studies are needed to determine the underlying biology and potential clinical application.
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Data availability
The clinical data are available from the NCI data Archive. The laboratory data are available from the first author.
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Acknowledgements
We gratefully acknowledge the invaluable contributions of the patients, their families, and the staff who participated in this study. The authors would also like to thank the Alliance Biorepository at the Ohio State University and administrative staff. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of National Cancer Institute. ClinicalTrials.gov Identifier: NCT00110214.
Funding
Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Numbers U10CA180821, U10CA180882, and U24CA196171 (to the Alliance for Clinical Trials in Oncology), UG1CA233180, UG1CA233253, and UG1CA233341 and NIH grant 5R01-CA256157. This research is supported by the United States Army Medical Research W81XWH-18-1-0278 and the Prostate Cancer Foundation Challenge Award. Detailed information is listed in https://acknowledgments.alliancefound.org. This work is also supported in part by funds from Genentech. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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ABN: Conceptualization, Supervision, data curation, funding acquisition, investigation, visualization, methodology, writing–original draft, writing–review and editing. YL: Data curation, investigation, visualization, methodology, writing–original draft, writing–review and editing. QY: formal analysis, validation, visualization, methodology, writing-original draft, writing-review and editing. BL: formal analysis, writing-review and editing. MDS: Data curation, methodology, writing–review and editing. JCB: Data curation, methodology, writing–review and editing. WKK: Conceptualization, data curation, methodology, writing–review and editing. HB, MJM, AJA: supervision, data curation, funding acquisition, investigation, methodology, writing-original draft, and revision/editing. DJG: Conceptualization, Supervision, data curation, funding acquisition, investigation, methodology, writing–original draft, writing–review and editing. SH: Conceptualization, Supervision, funding acquisition, formal analysis, validation, visualization, methodology, writing–original draft, writing–review and editing.
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A.B. Nixon has received research funding from Genentech, HTG Molecular Diagnostics, MedImmune/AstraZeneca, Medpacto, Promega Corporation, Seattle Genetics; and has received consultant/advisory compensation from AdjuVolt Therapeutics, Eli Lilly, GSK, Leap Therapeutics, Promega Corporation. D.J. George has received consultant/advisory compensation from Astellas, Astrazeneca, Axess Oncology, Bayer H/C Pharmaceuticals, BMS, Capio Biosciences, Constellation Pharmaceuticals, EMD Serono, Exelixis Inc., Flatiron, Ipsen, Janssen Pharmaceuticals, Merck Sharp & Dohme, Michael J Hennessey Associates, Modra Pharmaceuticals B. V., Myovant Sciences, Nektar Therapeutics, Physician Education Resource LLC, Pfizer, Propella TX, RevHealth LLC, Sanofi, UroGPO; and has received research funding from Astrazeneca, BMS, Calithera, Exelixis Inc., Janssen Pharmaceuticals, Novartis, Pfizer, Sanofi. H. Beltran has served as consultant/advisory board member for Janssen, Sanofi Genzyme, Astellas, Astra Zeneca, Merck, Pfizer, Foundation Medicine, Blue Earth Diagnostics, Amgen, Oncorus and has received research funding (to institution) from Janssen Oncology, AbbVie/Stemcentrx, Eli Lilly, Millennium Pharmaceuticals, Bristol Myers Squibb. A.J. Armstrong is a paid consultant with Pfizer, Astellas, Forma, BMS, Janssen, Bayer, Astrazeneca, Novartis, and Merck and receives research funding (to his institution) from Pfizer, Astellas, Janssen, Bayer, Dendreon, Novartis, Genentech/Roche, Merck, BMS, Astrazeneca, Constellation, Beigene, Forma, and Amgen. S. Halabi was on the DMC for Aveo, BMS, Janssen and Sanofi and receives research funding from Astellas and ASCO (Institution). The other authors declare no potential conflicts of interest.
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Nixon, A.B., Liu, Y., Yang, Q. et al. Prognostic and predictive analyses of circulating plasma biomarkers in men with metastatic castration resistant prostate cancer treated with docetaxel/prednisone with or without bevacizumab. Prostate Cancer Prostatic Dis (2024). https://doi.org/10.1038/s41391-024-00794-3
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DOI: https://doi.org/10.1038/s41391-024-00794-3