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Abiraterone treatment in castration-resistant prostate cancer selects for progesterone responsive mutant androgen receptors

The CYP17A1 inhibitor abiraterone markedly reduces androgen precursors and is thereby effective in castration-resistant prostate cancer (CRPC). However, abiraterone increases progesterone, which can activate certain mutant androgen receptors (AR) identified previously in flutamide-resistant tumors....

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Published in:Clinical cancer research 2015-03, Vol.21 (6), p.1273-1280
Main Authors: Chen, Eddy J, Sowalsky, Adam G, Gao, Shuai, Cai, Changmeng, Voznesensky, Olga, Schaefer, Rachel, Loda, Massimo, True, Lawrence D, Ye, Huihui, Troncoso, Patricia, Lis, Rosina L, Kantoff, Philip W, Montgomery, Robert B, Nelson, Peter S, Bubley, Glenn J, Balk, Steven P, Taplin, Mary-Ellen
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cited_by cdi_FETCH-LOGICAL-c529t-912fee6e5c74f3c75b592a49f13ac86c83494b62ea034d2110884bc00a7412473
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container_issue 6
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container_title Clinical cancer research
container_volume 21
creator Chen, Eddy J
Sowalsky, Adam G
Gao, Shuai
Cai, Changmeng
Voznesensky, Olga
Schaefer, Rachel
Loda, Massimo
True, Lawrence D
Ye, Huihui
Troncoso, Patricia
Lis, Rosina L
Kantoff, Philip W
Montgomery, Robert B
Nelson, Peter S
Bubley, Glenn J
Balk, Steven P
Taplin, Mary-Ellen
description The CYP17A1 inhibitor abiraterone markedly reduces androgen precursors and is thereby effective in castration-resistant prostate cancer (CRPC). However, abiraterone increases progesterone, which can activate certain mutant androgen receptors (AR) identified previously in flutamide-resistant tumors. Therefore, we sought to determine if CYP17A1 inhibitor treatment selects for progesterone-activated mutant ARs. AR was examined by targeted sequencing in metastatic tumor biopsies from 18 patients with CRPC who were progressing on a CYP17A1 inhibitor (17 on abiraterone, 1 on ketoconazole), alone or in combination with dutasteride, and by whole-exome sequencing in residual tumor in one patient treated with neoadjuvant leuprolide plus abiraterone. The progesterone-activated T878A-mutant AR was present at high allele frequency in 3 of the 18 CRPC cases. It was also present in one focus of resistant tumor in the neoadjuvant-treated patient, but not in a second clonally related resistant focus that instead had lost one copy of PTEN and both copies of CHD1. The T878A mutation appeared to be less common in the subset of patients with CRPC treated with abiraterone plus dutasteride, and transfection studies showed that dutasteride was a more potent direct antagonist of the T878A versus the wild-type AR. These findings indicate that selection for tumor cells expressing progesterone-activated mutant ARs is a mechanism of resistance to CYP17A1 inhibition.
doi_str_mv 10.1158/1078-0432.ccr-14-1220
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However, abiraterone increases progesterone, which can activate certain mutant androgen receptors (AR) identified previously in flutamide-resistant tumors. Therefore, we sought to determine if CYP17A1 inhibitor treatment selects for progesterone-activated mutant ARs. AR was examined by targeted sequencing in metastatic tumor biopsies from 18 patients with CRPC who were progressing on a CYP17A1 inhibitor (17 on abiraterone, 1 on ketoconazole), alone or in combination with dutasteride, and by whole-exome sequencing in residual tumor in one patient treated with neoadjuvant leuprolide plus abiraterone. The progesterone-activated T878A-mutant AR was present at high allele frequency in 3 of the 18 CRPC cases. It was also present in one focus of resistant tumor in the neoadjuvant-treated patient, but not in a second clonally related resistant focus that instead had lost one copy of PTEN and both copies of CHD1. 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The T878A mutation appeared to be less common in the subset of patients with CRPC treated with abiraterone plus dutasteride, and transfection studies showed that dutasteride was a more potent direct antagonist of the T878A versus the wild-type AR. These findings indicate that selection for tumor cells expressing progesterone-activated mutant ARs is a mechanism of resistance to CYP17A1 inhibition.</abstract><cop>United States</cop><pmid>25320358</pmid><doi>10.1158/1078-0432.ccr-14-1220</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record>
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source Freely Accessible Science Journals
subjects Aged
Aged, 80 and over
Androstenes - therapeutic use
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Cell Line, Tumor
DNA Helicases - genetics
DNA-Binding Proteins - genetics
Drug Resistance, Neoplasm - genetics
Dutasteride - therapeutic use
Humans
Ketoconazole - therapeutic use
Leuprolide - therapeutic use
Male
Middle Aged
Mutation - genetics
Progesterone - metabolism
Prostatic Neoplasms, Castration-Resistant - drug therapy
Prostatic Neoplasms, Castration-Resistant - genetics
PTEN Phosphohydrolase - genetics
Receptors, Androgen - genetics
Receptors, Androgen - metabolism
Steroid 17-alpha-Hydroxylase - antagonists & inhibitors
title Abiraterone treatment in castration-resistant prostate cancer selects for progesterone responsive mutant androgen receptors
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