Prostate-Specific Antigen Dynamics Predict Individual Responses to Intermittent Androgen Deprivation

BackgroundIntermittent androgen deprivation therapy (IADT) is an attractive treatment approach for biochemically recurrent prostate cancer (PCa), whereby cycling treatment on and off can reduce cumulative dose, limit toxicities, and delay development of treatment resistance. To optimize treatment within the context of ongoing intratumoral evolution, underlying mechanisms of resistance and actionable biomarkers need to be identified.\n\nMethodsWe have developed a quantitative framework to simulate enrichment of prostate cancer stem cell (PCaSC) dynamics during treatment as a plausible mechanism of resistance evolution.\n\nResultsSimulated dynamics of PCaSC and non-stem cancer cells demonstrate that stem cell proliferation patterns correlate with longitudinal serum prostate-specific antigen (PSA) measurements in 70 PCa patients undergoing multiple cycles of IADT. By learning the dynamics from each treatment cycle, individual model simulations predict evolution of resistance in the subsequent IADT cycle with a sensitivity and specificity of 57% and 94%, respectively and an overall accuracy of 90%. Additionally, we evaluated the potential benefit of docetaxel for IADT in biochemically recurrent PCa. Model simulations based on response dynamics from the first IADT cycle identify patients who would or would not benefit from concurrent docetaxel in subsequent cycles.\n\nConclusionOur results demonstrate the feasibility and potential value of adaptive clinical trials guided by patient-specific mathematical models of intratumoral evolutionary dynamics continuously updated with each treatment cycle.\n\nTranslational RelevanceCompared to continuous androgen deprivation therapy, intermittent androgen deprivation (IADT) has been shown to reduce toxicity and delay time to progression in prostate cancer. While numerous mathematical models have been developed to study the response to both continuous and intermittent androgen deprivation, very few have identified actionable biomarkers of resistance and exploited them to predict how patients will or will not respond to subsequent treatment. Here, we identify prostate-specific antigen (PSA) dynamics as the first such biomarker. Mechanistic mathematical modeling of prostate cancer stem cell dynamics that dictate prostate-specific antigen serum levels predicts individual responses to IADT with 90% overall accuracy and can be used to develop patient-specific adaptive treatment protocols, and potentially identify patients that may benefit from concurrent chemotherapy. Model results demonstrate the feasibility and potential value of adaptive clinical trials guided by patient-specific mathematical models of intratumoral evolutionary dynamics continuously updated with each treatment cycle.