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AR-V7 (empilhagem de receptor de androgénio variante 7) detectada em CTCs / ctDNA no mCRPC — preditivo...

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IDRF-PROSTATE-AR-V7-ARSI-RESISTANCE
TipoSinal de alerta
Estadoreviewed 2026-04-29 | pending_clinical_signoff
DoençasDIS-PROSTATE
FontesSRC-ESMO-PROSTATE-2024 SRC-NCCN-PROSTATE-2025

Origem da bandeira vermelha

DefiniçãoAR-V7 (androgen receptor splice variant 7) detected in CTCs / ctDNA in mCRPC — predictive marker of ARSI (abiraterone, enzalutamide, apalutamide, darolutamide) failure. PROPHECY (Antonarakis 2019): AR-V7-positive on Epic CTC IHC associated with HR ~3 for inferior PFS/OS on ARSI vs AR-V7-negative; switch to taxane (docetaxel, cabazitaxel) recovers responses. INFORMATIONAL — FDA has NOT approved any therapy decision keyed on AR-V7; surfaces in MDT brief to flag patients in whom ARSI-after-ARSI is unlikely to work.
Direcção clínicainvestigar
Categoriahigh-risk-biology

Lógica de Desencadeamento

{
  "any_of": [
    {
      "finding": "ar_v7",
      "value": "positive"
    },
    {
      "finding": "ar_v7_ctc",
      "value": "positive"
    },
    {
      "finding": "ar_v7_status",
      "value": "positive"
    },
    {
      "finding": "androgen_receptor_splice_variant_7",
      "value": "positive"
    }
  ],
  "type": "biomarker"
}

Notas

Detection: Epic AR-V7 Nucleus Detect (CTC-IHC) is the most-validated platform; requires ≥5 CTC per 7.5 mL blood for an interpretable result (lower CTC counts are non-informative, not negative). Alternatives: PCR-based AR-V7 mRNA on CTCs (Antonarakis 2014), ctDNA-based assays (less validated). Clinical use: in mCRPC patient who has progressed on first-line ARSI and is being considered for second-line ARSI (abiraterone-after-enzalutamide or vice-versa), AR-V7-positive status is a strong argument for switching to taxane chemotherapy or radioligand 177Lu-PSMA-617 (if PSMA-positive on PSMA-PET) instead. AR-V7-negative does NOT guarantee ARSI response (other resistance mechanisms exist — AR L702H/T878A/F877L LBD mutations, AR amplification, GR upregulation, lineage plasticity). KB scope choice (this chunk): ships as biomarker + RF (informational) only — no new IND, no algorithm step. Tx-modifying signal deferred to future chunk that authors a taxane-mCRPC IND branched on AR-V7 status.

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