No abstract

Background:Advances in the treatment of metastatic colorectal cancer (mCRC) in the last decade have significantly improved survival; however, simple biomarkers to predict response or toxicity have not been identified, which are applicable to all community oncology settings worldwide. The use of inflammatory markers based on differential white-cell counts, such as the neutrophil/lymphocyte ratio (NLR), may be simple and readily available biomarkers.Methods:Clinical information and baseline laboratory parameters were available for 349 patients, from two independent cohorts, with unresectable mCRC receiving first-line palliative chemotherapy. Associations between baseline prognostic variables, including inflammatory markers such as the NLR and tumour response, progression and survival were investigated.Results:In the training cohort, combination-agent chemotherapy (P=0.001) and NLR⩽5 (P=0.003) were associated with improved clinical benefit. The ECOG performance status ⩾1 (P=0.002), NLR>5 (P=0.01), hypoalbuminaemia (P=0.03) and single-agent chemotherapy (P<0.0001) were associated with increased risk of progression. The ECOG performance status ⩾1 (P=0.004) and NLR>5 (P=0.002) predicted worse overall survival (OS). The NLR was confirmed to independently predict OS in the validation cohort (P<0.0001). Normalisation of the NLR after one cycle of chemotherapy in a subset of patients resulted in improved progression-free survival (P=0.012).Conclusion:These results have highlighted NLR as a potentially useful clinical biomarker of systemic inflammatory response in predicting clinically meaningful outcomes in two independent cohorts. Results of this study have also confirmed the importance of a chronic systemic inflammatory response influencing clinical outcomes in patients with mCRC.

The link between chronic inflammation and increased risk of developing some cancers is well established. The molecular mechanisms that underlie this process (cause) as well as the chronic inflammation that accompanies cancer (consequence) continue to be elucidated. Cancer-associated inflammation has effects on the ability of cancers to metastasize, on the clinical manifestations of cancer, and on the ability of the patient to tolerate anticancer therapy. The identification of biomarkers of cancer-associated inflammation will assist in identifying patients at risk of its consequences.

Patient‐related factors, especially markers of inflammatory response, are prognostic in many common solid cancers. Here we review how such markers, in particular the acute‐phase proteins C‐reactive protein and albumin and a differential white cell count, can predict treatment outcomes in cancer patients. The review examines the literature pertaining to surgery, chemotherapy, and radiotherapy and discusses how inflammatory markers might be incorporated into the planning and monitoring of cancer treatments. Clinical Pharmacology & Therapeutics (2011) 90 3, 475–478. doi: