Analysis of Androgene Receptors Axis and DNA Damage Repair Genes in Patients With Prostate Cancer

Prostatic Neoplasms Clinical Trial

Official title:

Analysis of Androgene Receptors Axis and DNA Damage Repair Genes From Plasma DNA (ctDNA) in Patients With Prostate Cancer

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT03677414
• Other study ID #: FWF Project KLI 710-B26
• Secondary ID: 21-228 ex 09/10
• Status: Active, not recruiting
• Start date: September 10, 2018
• Est. completion date: August 31, 2021

Study information

• Verified date: September 2018
• Source: Medical University of Graz
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

In this project, we would like to focus on castration-sensitive prostate cancer (CRPC). This is a highly variable clinical picture with differentiated and burdening symptoms. The clinical parameters used to estimate the prognosis have so far only shown a very limited valence; genetic markers have so far only rarely been investigated.

In the course of our preliminary investigations, we were already able to isolate 189 plasma samples from 59 patients with metastatic prostate cancer. These samples are prepared by highly innovative techniques, e.g. "whole genome sequencing", in order to gain comprehensive insights into the spectrum of genetic changes under therapy and the associated tumor evolution. These results should be compared with the genetic material of the respective prostate tumors, which originate from previous operations. This highly comprehensive data, which will yield results on copy number changes, mutations, and gene expression, will allow analysis of signaling pathways of unprecedented resolution to increase the efficacy of targeted therapies in patients and minimize the burden of non-effective therapy side effects.

Description:

The investigators collected 189 plasma samples from 59 patients with metastasized CRPC treated with abiraterone/enzalutamide. In order to stratify plasma DNA samples based on the presence of low (i.e. z-score ≤5; corresponds to <10% ctDNA) versus high (z-score >5; corresponds to ≥10% ctDNA) genomic complexity in ctDNA the investigators employed the modified Fast Aneuploidy Screening Test-Sequencing System (mFAST-SeqS), which provides a plasma based marker of aneuploidy (z-score). Altogether 106 plasma samples with a low z-score will be evaluated only with the AVENIO ctDNA Expanded Kit, which is capable of detecting mutations with VAFs as low as 0.1% . From the 83 plasma samples with increased z-score will be sequenced with high coverage (70x) so that both mutations and nucleosome positions can be extracted from the obtained sequences. With the other 32 high z-score samples plasma-Seq will be conducted to establish genome-wide copy number profiles and 31 prostate cancer genes will be enriched to screen for mutations in these genes.

At present, there is no evidence what parameters should be used to decide which treatment options are best for metastatic prostate cancer patients. The suggested innovative technologies, i.e. nucleosome position mapping and gene expression analyses will provide systematic maps of nucleosome positions. The sequencing of plasma samples with 70x will provide in addition a comprehensive view on the mutation spectrum in metastatic prostate cancer. By inclusion of primary tumor analyses, an unprecedented view on prostate cancer genome Evolution will be obtained. Overall, the comprehensive data set (copy number changes, mutations, gene expression) will allow pathway analyses with unprecedented resolution.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 59
• Est. completion date: August 31, 2021
• Est. primary completion date: January 31, 2021
• Accepts healthy volunteers: No
• Gender: Male
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• subject has proven histological diagnosis of prostate cancer

• subject was treated with abiraterone and/or enzalutamide.

Exclusion Criteria:

• patient rejects the participation

Related Conditions & MeSH terms

• Prostatic Neoplasms

Locations

Country	Name	City	State
Austria	Institute of Human Genetics, Medical University of Graz	Graz

Sponsors (1)

Lead Sponsor	Collaborator
Medical University of Graz

Country where clinical trial is conducted

Austria, 

References & Publications (3)

Ulz P, Belic J, Graf R, Auer M, Lafer I, Fischereder K, Webersinke G, Pummer K, Augustin H, Pichler M, Hoefler G, Bauernhofer T, Geigl JB, Heitzer E, Speicher MR. Whole-genome plasma sequencing reveals focal amplifications as a driving force in metastatic prostate cancer. Nat Commun. 2016 Jun 22;7:12008. doi: 10.1038/ncomms12008. — View Citation

Ulz P, Heitzer E, Speicher MR. Co-occurrence of MYC amplification and TP53 mutations in human cancer. Nat Genet. 2016 Feb;48(2):104-6. doi: 10.1038/ng.3468. — View Citation

Ulz P, Thallinger GG, Auer M, Graf R, Kashofer K, Jahn SW, Abete L, Pristauz G, Petru E, Geigl JB, Heitzer E, Speicher MR. Inferring expressed genes by whole-genome sequencing of plasma DNA. Nat Genet. 2016 Oct;48(10):1273-8. doi: 10.1038/ng.3648. Epub 2016 Aug 29. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Nucleosome positioning patterns	Here, samples with increased z-score (z-score >5; corresponds to =10% ctDNA; modified Fast Aneuploidy Screening Test-Sequencing System (mFAST-SeqS)) will be sequenced with high coverage (70x) so that nucleosome positions can be extracted from the obtained sequences. As at TSSs (transcriptional start site), the nucleosome occupancy results in different read-depth coverage patterns in expressed and silent genes (Ulz et al., Nat Genet 2016), systematic maps of nucleosome positions in defined patients will be generated.	3 years
Secondary	Focal amplifications in ctDNA	Mapping (absolute number and size) of recurrent focal amplifications/gained regions and identification of the driver genes within these amplicons by systematic cataloging of genes expressed in focal amplifications/gained regions. In order to facilitate the identification of focal amplifications we apply very stringent/conservative criteria regarding amplicon size and gene density, which we applied in previous publications (Ulz et al., Nat Commun 2016; Ulz, Heitzer, Speicher, Nat Genet 2016).	3 years
Secondary	Prostate Cancer Panel	Characterization of mutation frequency of enriched prostate cancer genes using plasma-Seq (i.e. AKAP9, APC, AR, ATM, BRAF, BRCA1, BRCA2, CTNNB1, EGFR, ERG, FOXA1, GNAS, GRIN2A, HRAS, KRAS, MED12, MLL, MLL2, MLL3, MLLT3, NOTCH1, NRG1, PIK3CA, PIK3CB, PIK3R1, PTEN, RB1, SPOP, TMPRSS2, TP53, ZFHX3).	3 years
Secondary	Clinico-pathological characteristics	Documentation of clinico-pathological characteristics (PSA, NSE; blood count; localization, number and size of metastases by imaging) including prior and subsequent therapies.To identify predictive/prognostic biomarkers, newly occurring genomic changes in the plasma DNA (see primary outcome and further secondary outcome measures) will be correlated with outcomes of given therapies.	3 years
Secondary	Analyses of primary tumors	Measurement of copy number changes in primary tumors by next-generation sequencing, i.e. SCNA-seq, and RNA-Seq for comparison with the nucleosome positions, see above.	3 years
Secondary	Buccal swap	Distinction germ line vs. somatic mutations	3 years