The Lank Center for Genitourinary Oncology at Dana-Farber Cancer Institute presents a succinct summary of all the testicular cancer clinical updates you need to know from ASCO GU 2023.
So we're gonna finish today with Highlights from Oscar G 2023 focused on testicular cancer. Dr will be presenting the testicular cancer updates and I want to point out that he is the sole presenter and discussing as he was the expert discussed at the meeting and so is very, very capable of giving us a quick and in depth overview of this abstract Dr. Torrey. Thank you very much as with all G you meetings. It was a rip roaring set of events in testicular cancer. There's one abstract that I will I want to highlight and this is in the context of a potential new developing biomarker for the presence or absence of germ cell tumor. Um The context of this is that the current biomarkers we have are pretty poor. The positivity of AFP and HCG is very low, especially in early disease. And if you look across all stages, barely 50% of tumors will have at least one positive blood biomarker to really help you feel somewhat confident that you know what you're dealing with. So this abstract was on longitudinal evaluation of plasma micro RNA 3 71 to detect minimal residual disease and early relapse of germ cell tumors and was presented by a group from Vancouver. This slide shows some of the more recent data looking at micro RNA 3 71. This is a finding that's about 15 years old but has kind of been moving into clinical development. So these studies are things to notice across different contexts. In early stage disease. The presence of Micro RNA 3 71 has a really high sensitivity albeit in small patient sample numbers and a very excellent specificity for the presence of germ cell tumor. This across histology. I think one thing to note is that sometimes the methods of extracting the micros are a little bit different and that's something we'll have to pay attention to in the future. In this study, the authors basically took advantage of a plasma bank that is in British Columbia and Canada. And they identified clinical stage. One testicular cancer patients who had banked plasma as part of this banking study within three months of their or key ectomy and then followed them longitudinal E to see if they could detect relapse. And so there were a total of 68 patients that were valuable on this study and 15 of those patients relapsed the patients seemed to be representative of the clinical stages in time to relapse. So it seemed like a reasonable patient population. And what you see here is in contrast to some of the prior studies, I showed the sensitivity likely related to just really small volumes of disease being present at the time of relapse. There's only 53% for the patients who eventually relapse. Whereas the specificity was 100%. So this is a no false positive situation which is really, I think, incredible and I think will bear watching to see if this pans out. And I think the interesting thing here is that positivity of the biomarker proceeded clinically of a disease by about three months on by median. So it could be something that pretends closer observation or really highlighting the emphasis highlighting the need for surveillance. This is being more prospectively validated in the SWAT S 18 23 which is a longitudinal cohort study, basically looking at the association in early stage disease between the micro RNA and conventional ways of detecting relapse. That study is about 70% of cruise. So there'll be a preliminary analysis probably at the end of 2023 there are other studies in process including using micro RNA for surgical determination because you can imagine that if you have a residual mass and you're not sure if it's a process or terra toma, perhaps you could use the circulating biomarker to try and delineate that. And so this majestic study run out of U C L A is uh sorry out of California is one of the potential ways that will answer this question. It's really unclear to me how this is going to impact management completely. I think it's a very clear finding that this biomarker is interesting and metastatic disease but how it's going to be used especially in clinical stage. One disease is unclear specifically, it's unclear does micro RNA positivity in clinical stage one disease? Is that the same as tumor marker positivity? So do we have to treat it like clinical stage one S disease and give chemo or is this something that really just is kind of a stronger case for giving admin therapy? Um So I think that's kind of the one thing that this abstract specifically kind of raises the question of and I think will really require a lot more study to really answer that question. I do think that this has the potential to be a good biomarker. It's really very specific. Although the sensitivity is lower, there's a lot of data coming to show that it's reproducible and it's pretty cheap, it only costs about $70 per essay. Uh and so I think as long as we can get a good basis for whether this impacts management, I think it's very promising. This side is only to show that there are other biomarkers, expression of these markers, potentially could help identify terra toma and post chemotherapy specimens. And so groups that are working on these findings are looking at basically pet based tracers for these genes to try and see if that could help as another noninvasive biomarker. And so just to conclude this very brief kind of summary, micro RNA is an interesting biomarker that we should just kind of be on the lookout for, for thinking about how to manage our testicular cancer patients. Although a lot of work needs to be done. That is all. And thank you very much for your time.
