Shalini Moningi: Hi, Dr. Jia. Thank you so much for having me. Excited to be here.
Angela Jia: Thank you. Can you tell us a little bit about what this project was?
Shalini Moningi: Yeah, definitely. So our team looked at evaluating the prognostic value of the Decipher Prostate Genomic Classifier test in patients with de novo metastatic disease in prostate cancer. And this was a real-world data analysis. So in our project, we looked at patients who presented with de novo metastatic disease and patients who had matched clinical criteria and had localized disease with prostate cancer. And we took a deep dive into their Decipher score and some additional details that we found in addition to just their Decipher score. And overall, we found that patients that present with de novo metastatic disease tend to have higher Decipher scores regardless of their Gleason component when comparing it in a matched format to the localized patients who did not have metastatic disease. We also found that these patients, of course, presented with a higher baseline PSA. And most importantly, we also found that patients with de novo metastatic disease had higher rates of PTEN inactivity and luminal B subtype tumors compared to patients who had localized disease. And so this is just one of the first studies looking at a large linkage pattern where we're linking clinical factors and Decipher tests together to figure out how these patients present. And our hope is that we use this data in future studies and maybe even future prospective studies to see if Decipher scoring can help us with risk stratification and treatment delivery and intensification or de-intensification.
Angela Jia: Thank you. That's very helpful. And that's very exciting to see such a large number of patients that you examined. To clarify, so these are patients ... Because usually when we think about Decipher, we're thinking about getting this test in someone who has localized prostate cancer where it has not spread. So the patients you looked at, they already had disease that had spread at diagnosis?
Shalini Moningi: That's a great question. Yes. So we looked at clinical factors, and we identified patients who presented with metastatic disease upfront at the time of their diagnosis, that's correct. So we compared that cohort with a cohort of patients with localized disease or who presented with localized disease. And we matched for clinical factors, and then further investigated Decipher score as well as specific genomic expression.
Angela Jia: Got it. And very interesting, you mentioned some other biomarkers in there that I think maybe patients aren't as aware of. I think you mentioned PTEN inactivity and luminal B subtype. Can you just describe what those are?
Shalini Moningi: Yeah, that's a great point. So PTEN is actually a tumor suppressor gene in the body, and its main purpose is really to control excess growth and to potentially also control cancer tumor growth. So one can imagine that if your PTEN tumor suppressor gene is not working or it's suppressed for some reason, that allows cancers or tumor cells to really grow and replicate, which can be a problem. So Decipher score, and specifically the GRID, which is a part of your Decipher score if you get a Decipher score for a patient, shows whether there is PTEN inactivity or not. And it shows us basically if this gene is lost, mutated, or not functioning. And this gives us a better idea of how aggressive the tumor cell is and how aggressive it's behaving. Now, luminal B is a specific subtype of prostate cancer cells. It's a molecular subtype, and it's been initially seen in the breast cancer population and now starting to be seen in the prostate population. And so you have luminal A, which tend to be less aggressive and luminal B that tend to be a bit more aggressive. What's interesting is there has been some data looking at responsiveness to hormone therapy in the luminal B subtype. And so that's interesting in this population because in the future, our hope is that getting a Decipher score, potentially for someone with de novo metastatic disease or oligometastatic disease, might help us in picking out patients who might actually benefit more from certain types of hormone therapies or dose intensification of hormone therapy. So these are two things that were interesting findings in this large-cohort analysis.
Angela Jia: Thank you so much. And how do you see this changing the way doctors and patients decide on treatment plans if they came into clinic tomorrow?
Shalini Moningi: Thanks, Dr. Jia. So we're just at the tip of the iceberg in terms of figuring out personalized care in the metastatic world. There have been a lot of prospective studies looking at oligorecurrent prostate cancer. There are not as many, unfortunately, in the de novo metastatic setting when we think about radiation and dose intensification of hormone therapy. And so I think this is just the beginning of us potentially considering different degrees in terms of duration or intensification of hormone therapy for patients with de novo metastatic disease. And specifically, we're both radiation oncologists, so we talk about oligometastatic disease or de novo oligometastatic disease. So right now, these are really exciting results. I don't know if it's necessarily practice-changing in terms of what we're going to be treating patients with at this time. However, I think there's going to be a lot of changes probably in the next couple of years and applying some of this into prospective clinical trials where we can really get gold standard data to potentially modify patient's treatment plans, whether that's decreasing their ADT duration or intensifying their ADT type, and even potentially some answers with radiation and how extensive we should be for these patients. So it's exciting. I think it's a really great first step in trying to personalize treatment for patients with metastatic disease.
Angela Jia: Thank you so much for sharing your data with us.
Shalini Moningi: Thank you so much. I'm happy to be here and excited to share all this information with you all.