The Decipher Prostate Genomic Classifier test successfully identifies which metastatic prostate cancer patients benefit most from docetaxel chemotherapy, with high-scoring patients showing a 36% reduction in death risk versus less than 4% for low-scoring patients. This represents the first molecular test with randomized trial evidence to guide chemotherapy decisions in metastatic prostate cancer.
Study Design & Population
- Phase III randomized trial (STAMPEDE) with 1,523 patients with advanced prostate cancer
- 832 patients specifically had metastatic disease at diagnosis
- All patients received androgen deprivation therapy (ADT) as standard treatment
- Median follow-up of 14 years with additional docetaxel or abiraterone testing
- Patients underwent Decipher Prostate Genomic Classifier testing on routine prostate tissue
Key Findings
- High Decipher scores: 36% reduction in risk of death with docetaxel treatment
- Low Decipher scores: Less than 4% reduction in risk of death with docetaxel
- Test successfully stratifies patients into docetaxel-sensitive versus docetaxel-resistant groups
- PTEN inactivity signature identified as additional predictor of chemotherapy benefit
- Results enable personalized treatment decisions based on tumor molecular profile
Clinical Implications
- First molecular test with Level 1 evidence for guiding metastatic prostate cancer chemotherapy
- Allows avoidance of unnecessary chemotherapy toxicity in patients unlikely to benefit
- Already commercially available and reimbursed in the US for treatment selection
- May improve quality of life by sparing non-responders from docetaxel side effects
- Supports precision oncology approach in advanced prostate cancer management
Limitations
- Study population limited to patients enrolled in STAMPEDE trial protocols
- Long-term follow-up required (14 years) may limit immediate clinical application
- Cost-effectiveness analysis not provided in current publication
- Validation in diverse populations and healthcare systems needed
- Integration into clinical workflows requires additional implementation studies
