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000310009 1001_ $$0P:(DE-He78)5d89608549b9211240ddca14dc023a74$$aAmghar, Mariam$$b0$$eFirst author$$udkfz
000310009 245__ $$aGenomic analysis in chemotherapy-naïve prostate cancer prior to PSMA-targeted treatment.
000310009 260__ $$aLausanne$$bFrontiers Media$$c2026
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000310009 520__ $$aChemotherapy is typically administered prior to consideration of tandem [225Ac]Ac-/[177Lu]Lu-PSMA-617 therapy in metastatic castration-resistant prostate cancer (mCRPC), making chemotherapy-naïve patients who undergo tandem radionuclide treatment extremely rare. The genomic mechanisms dictating response and resistance to prostate-specific membrane antigen-radiopharmaceutical therapy (PSMA-RPT) in this setting remain unclear. While tandem therapy is expanding for aggressive disease, baseline genomic predictors of treatment outcomes are not well defined. We present rare chemotherapy-naïve mCRPC cases treated with tandem PSMA-RPT and explore their molecular characteristics through plasma circulating tumor DNA (ctDNA).Blood samples were obtained from mCRPC patients receiving [225Ac]Ac-/[177Lu]Lu-PSMA-617 therapy. Cell-free DNA (cfDNA) was isolated and analyzed using ultra-low pass whole-genome sequencing (ULP-WGS). Genome-wide copy number alterations (CNAs) and tumor fraction (TFx) were inferred with the ichorCNA algorithm.This case series included five chemotherapy-naïve patients-four with baseline characterization and one with longitudinal follow-up-providing a rare window into cfDNA CNAs at treatment initiation. Recurrent alterations included amplifications in chromosomes 1q, 7q, and 8q, and losses in 8p. Additional events such as 12q amplification and partial 9q gain were also observed. In Patient 5, serial cfDNA analysis demonstrated stable 8p loss and 8q gain across multiple treatment cycles, despite clinical progression, suggesting clonally persistent genomic drivers.Baseline cfDNA CNA profiling in chemotherapy-naïve mCRPC reveals recurrent chromosomal imbalances-particularly 8p loss and 8q gain-that may represent intrinsic, stable features of advanced disease. These findings highlight the exploratory potential of cfDNA-based genomics in rare PSMA-RPT cohorts.
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000310009 650_7 $$2Other$$aPSMA
000310009 650_7 $$2Other$$acfDNA
000310009 650_7 $$2Other$$achemotherapy-naïve
000310009 650_7 $$2Other$$acopy number alternations
000310009 650_7 $$2Other$$amCRPC
000310009 650_7 $$2Other$$aradiopharmaceutical therapy
000310009 650_7 $$2Other$$atandem actinium-lutetium therapy
000310009 7001_ $$0P:(DE-He78)1a25bc9516a97a13551ebd083356d24f$$aRoscher, Mareike$$b1$$udkfz
000310009 7001_ $$aRausch, Tobias$$b2
000310009 7001_ $$aÖzgür, Hilal$$b3
000310009 7001_ $$0P:(DE-He78)033d979f00729281e709b85fe6cae972$$aBauder-Wüst, Ulrike$$b4$$udkfz
000310009 7001_ $$aBruchertseifer, Frank$$b5
000310009 7001_ $$aMorgenstern, Alfred$$b6
000310009 7001_ $$aBeneš, Vladimír$$b7
000310009 7001_ $$aKratochwil, Clemens$$b8
000310009 7001_ $$0P:(DE-He78)0f034e05cefb010f991ef8b96009d95c$$aBenesova-Schäfer, Martina$$b9$$eLast author$$udkfz
000310009 773__ $$0PERI:(DE-600)2649216-7$$a10.3389/fonc.2026.1741080$$gVol. 16, p. 1741080$$p1741080$$tFrontiers in oncology$$v16$$x2234-943X$$y2026
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