Researchers at Dana-Farber Cancer Institute and the University of Trento have developed a blood test that can distinguish neuroendocrine prostate cancer (NEPC) from other types of advanced prostate cancer. NEPC is a particularly challenging cancer to treat, and current diagnostic methods typically involve a biopsy of tumor tissue from a metastatic site, which can be unreliable due to tumor heterogeneity. The newly developed blood test, called NEMO (NEuroendocrine MOnitoring panel), detects specific epigenetic changes, known as DNA methylation changes, that differentiate NEPC from other types of prostate cancer.
NEPC arises when castration-resistant prostate cancer (CRPC) transitions from adenocarcinoma to a neuroendocrine subtype. In this transition, cancer cells stop expressing the androgen receptor and develop resistance to treatment. NEPC is currently diagnosed in approximately 10-15% of patients with metastatic prostate cancer. The NEMO blood test can identify the tumor type as either CRPC-adenocarcinoma or NEPC and can also determine the tumor burden based on the ratio of tumor DNA to normal DNA in the blood.
The research team tested NEMO in preclinical models of prostate cancer, as well as in blood samples from patients with known prostate cancer subtypes. The test had a high level of accuracy in identifying different subtypes of prostate cancer. Additionally, NEMO was evaluated in two clinical trials of patients with aggressive CRPC. The test’s estimation of tumor burden was consistent with other accepted measures, suggesting that it could be used to monitor treatment response. Importantly, NEMO was able to identify patients with NEPC based on pathology reports and even detect signs of a transition to NEPC in patients who had not been diagnosed with the condition.
The researchers believe that the NEMO blood test could have significant clinical implications. It could help clinicians predict which patients will respond to specific treatments for prostate cancer, including targeted therapies for NEPC. Moreover, the information provided by the test could assist in the selection of appropriate treatments and further contribute to the understanding of the disease. The researchers also envision that the test’s approach could potentially be extended to other types of cancer to distinguish between subtypes.
In the long term, the research team aims to move forward with translating the NEMO blood test into a clinical tool that physicians can use to improve patient care. The test has the potential to aid in early detection, monitoring treatment response, and guiding treatment decisions in patients with advanced prostate cancer.