RESUMEN
The prognosis for patients with metastatic castration-resistant prostate cancer (mCRPC) varies, being influenced by blood-related factors such as transcriptional profiling and immune cell ratios. We aimed to address the contribution of distinct whole blood immune cell components to the prognosis of these patients. This study analyzed pre-treatment blood samples from 152 chemotherapy-naive mCRPC patients participating in a phase 2 clinical trial (NCT02288936) and a validation cohort. We used CIBERSORT-X to quantify 22 immune cell types and assessed their prognostic significance using Kaplan-Meier and Cox regression analyses. Reduced CD8 T-cell proportions and elevated monocyte levels were substantially connected with a worse survival. High monocyte counts correlated with a median survival of 32.2 months versus 40.3 months for lower counts (HR: 1.96, 95% CI 1.11-3.45). Low CD8 T-cell levels were associated with a median survival of 31.8 months compared to 40.3 months for higher levels (HR: 1.97, 95% CI 1.11-3.5). These findings were consistent in both the trial and validation cohorts. Multivariate analysis further confirmed the independent prognostic value of CD8 T-cell counts. This study highlights the prognostic implications of specific blood immune cells, suggesting they could serve as biomarkers in mCRPC patient management and should be further explored in clinical trials.
RESUMEN
Prostate cancer is the second mortality cause among males with cancer. Patients with metastatic castration resistant prostate cancer (mCRPC) essentially die due to tumor progression in a castration resistance situation. Docetaxel based chemotherapy was the first therapeutic strategy that demonstrated a survival increase, in addition to pain decrease, increase in tumor responses and quality of life benefit, and it currently continues being useful after the incorporation of new therapies for the treatment of mCRPC. Cabazitaxel, a taxane with efficacy in docetaxel resistant tumors, was the second drug demonstrating increased survival in this scenario, and it is an additional alternative option effective in selected patients. Patients with aggressive variants and those with DNA repair genes alterations may benefit from platin-based therapies. In the absence of validated biomarkers, we should base our decisions on clinical and patient's preferences criteria. It is important to design a comprehensive therapeutic plan at an early stage including the treatments with demonstrated efficacy on survival. For this, it is essential a comprehensive and multidisciplinary evaluation of the patient at the start of therapy and during tumor evolution. This evaluation must be done with an adequate information process and shared decision together with the patient.