Researchers from the Dana-Farber Cancer Institute and the University of Trento, Italy, have developed a groundbreaking blood test that distinguishes neuroendocrine prostate cancer (NEPC) from adenocarcinoma, providing a non-invasive method to detect this transition in the advanced stage of the disease. NEPC is a challenging form of prostate cancer, and as treatments become more effective, there is a rise in treatment-resistant types like NEPC.
The current diagnosis of NEPC involves an invasive tumor biopsy from a metastatic tumor, but determining the optimal time for this procedure is challenging, and results can be inconclusive due to tumor heterogeneity. The newly developed blood test, named NEMO (NEuroendocrine MOnitoring panel), leverages previous research on genetic and epigenetic changes associated with NEPC development. It focuses on examining cell-free DNA (cfDNA) shed by tumors in the blood, specifically targeting methylation changes across the genome.
The NEMO test distinguishes between castration-resistant prostate cancer (CRPC) and NEPC by measuring the methylation of relevant DNA fragments in blood plasma. By analyzing a minimal and efficient panel of genes, NEMO can report both the tumor fraction, indicating disease burden, and the tumor type, whether CRPC or NEPC. The test provides a score on a continuum, accommodating cases where the cancer may be transitioning between subtypes.
The researchers have successfully evaluated NEMO in preclinical models and blood samples from various patient cohorts with known prostate cancer subtypes. Clinical trials involving aggressive CRPC patients demonstrated consistent results, suggesting that NEMO could monitor treatment effectiveness by indicating decreased tumor burden, especially crucial after the cancer has transitioned to NEPC. The researchers aim to explore the test’s potential in predicting patient responses to specific prostate cancer treatments targeting NEPC.