From December 2019 to April 2023, genetic testing using a cancer genome gene panel will be conducted on 2,991 patients (OncoGuideTM NCC oncopanel test: 679 patients, Foundation One CDx test: 2312 patients) at the Cancer Genome Medicine Department of a national university in Japan in order to consider the next treatment method. In cancer genomic medicine, 298 cases of advanced castration-resistant prostate cancer (CRPC) among 2991 cases of advanced/metastatic cancer were examined using a cancer genome gene panel.

Based on the results of the cancer genome gene panel of 298 cases of advanced castration-resistant prostate cancer, Pathogenic variants (PVs) within the BRCA1/2 genes in 38 cases; PVs within the CDK12 gene in 27 cases; PVs within the ATM gene in 25 cases; PVs within the RAD51 gene in 19 cases; Tumor Mutation Burden (TMB)-High (>10) in 33 cases; Microsatellite instability (MSI)-High in 16 cases was detected. At a clinical conference on cancer genomic medicine, PARP inhibitors (Olaparib, Niraparib, or platinum drugs) for CRPC patients with BRCA1/2 PVs, Pembrolizumab, immune checkpoint inhibitor for patients with TMB-H, Pembrolizumab for patients with MSI-H were prescribed and administered to individual patients as a drug covered by insurance.

Based on the cancer genome gene panel test results (Table) published in JAMA Oncology for patients with advanced CRPC, our medical institution recommends the use of pembrolizumab for patients with advanced CRPC. Pembrolizumab can be prescribed and administered as a drug covered by insurance. However, based on the result obtained from the cancer genome gene panel test using tissue from this patient's advanced CRPC, the TMB-H value was 10, which is a low value. Therefore, it is thought that the efficacy of pembrolizumab in patients with advanced CRPC may be low. JAMA Oncology indicates D as the correct answer. The discussions in JAMA Oncology are extremely useful for our medical staff who are conducting cancer genomic medicine.

We do not have potential conflicts of interest.

Doctor specializing in cancer genome medicine　　　　　　　　　　　Doctor specializing in emerging infectious diseases

Published in JAMA Oncology on October 27, 2023. by Kyoto@takumaH