A digital pathology-based multimodal artificial intelligence (MMAI) model, the ArteraAI Prostate Test, has demonstrated its ability to predict overall survival and response to metastasis-directed therapy in patients with oligometastatic castration-sensitive prostate cancer. The findings, presented at the 2024 ASTRO annual meeting by Dr. Philip Sutera, suggest that this biomarker could help personalize treatment strategies for this patient population.
The study involved a retrospective review of 222 men with oligometastatic castration-sensitive prostate cancer (defined as <= 5 metastases) who were evaluated with MMAI scoring. The primary objective was to compare overall survival between patients with high- and low-MMAI scores. A secondary objective assessed MMAI's predictive ability for metastasis-directed therapy treatment effect in a subset of patients from the STOMP and ORIOLE randomized clinical trials.
MMAI Score and Overall Survival
Patients with high MMAI scores (> 0.527) presented with more aggressive disease characteristics, including higher PSA at diagnosis (9.61 versus 5.95, p < 0.001), higher Gleason score (p < 0.001), a greater likelihood of de novo metastatic disease (28.8% versus 8.1%, p < 0.001), and a higher incidence of bone metastases (55.5% versus 39.6%, p = 0.019).
Overall survival was significantly worse in patients with high MMAI scores (HR 7.88, 95% CI 1.62-36.49), with a median overall survival of 108.4 months compared to those with low MMAI scores, who had not reached median survival during the follow-up period.
Predictive Value for Metastasis-Directed Therapy
In a subset of 51 patients from the STOMP and ORIOLE trials, MMAI was not prognostic for metastasis-free survival (HR 1.24, 95% CI 0.64-2.43, p = 0.52). However, MMAI proved predictive for the benefit of metastasis-directed therapy. Patients with high MMAI scores demonstrated a significant improvement in metastasis-free survival when treated with metastasis-directed therapy (HR 0.32, 95% CI 0.12-0.90; p = 0.03), while those with low MMAI scores did not show the same benefit (HR 1.59, 95% CI 0.63-4.04; p = 0.33; p-interaction = 0.02).
Clinical Implications
These findings suggest that the ArteraAI MMAI biomarker can identify patients with oligometastatic castration-sensitive prostate cancer who are at higher risk of death and who are more likely to benefit from metastasis-directed therapy. According to Dr. Sutera, further validation is needed to refine the use of this biomarker in personalizing the management of patients with oligometastatic castration-sensitive prostate cancer.
