Thread by @Nick_Terrigino

I’m delighted to share the latest publication from the NCI GU Malignancies Center of Excellence, “Sequential prostate MRI in high-risk prostate cancer treated with neoadjuvant enzalutamide is predictive of therapeutic response” published today in @CCR_AACR clincancerres.aacrjournals.org/content/early/…

@radiolobt @NCIResearchCtr @HuihuiYe_MD @PeterPintoMD @gulleyj1 @PChoyke @theNCI #pcsm #prostatecancer

Although most patients diagnosed with higher risk prostate cancer receive surgery or radiation a newer approach is to treat up-front with targeted therapy. We can determine how well the therapy worked by comparing the amount of tumor before treatment to the amount after treatment

Historically, this has been estimated using biopsies and surgery specimens. We wanted to see whether multiparametric MRI (cancer.gov/publications/d…) could visualize tumor response. We also asked if any imaging feature predicted response.

Patients received an MRI before treatment with the targeted therapy enzalutamide. Then they received another MRI right before surgery. The amount of tumor visualized on the second MRI correlated well with what was reported by study pathologists.

You’ll notice that some patients had very low volumes of residual tumor, and some none at all. We call these “exceptional responders.” (cancer.gov/about-cancer/t…) Those patients with less tumor are less likely to experience recurrence in the future.

But the treatment worked on almost every patient. Enzalutamide targets the androgen receptor (AR), and post-treatment expression of AR was reduced in almost every case.

Next we looked at different mathematical features from the MRI. We found that baseline tumor volume was usually greater in poor responders, and the amount of tumor adjusted by total prostate volume was even more predictive.

Ongoing efforts, including our recent preprint (medrxiv.org/content/10.110…), attempt to further describe molecular features that distinguish those patients who respond poorly from those for whom neoadjuvant intense ADT works exceptionally well.

This study would not be possible without the contributions of patients and their families. Thank you to all investigators involved in this work. Thank you to our funding sources.