Summary C-reactive protein (CRP) levels in serum were measured in fifteen patients with metastatic colorectal carcinoma, prior to and during treatment with a continuous intravenous infusion of rIL.2. Patients were subsequently classified as responders or non-responders to this therapy. Baseline serum CRP levels, prior to treatment, were significantly lower in the responders (range <2-8 mg-1) when compared with the non-responders (range 7.5-116 mg 1'), P = 0.004. Furthermore, the responding patients demonstrated significantly and grossly elevated CRP stimulation indices (SI) compared with non-responders at different time intervals during the rIL2 infusion. At the cessation of rIL2 therapy, the CRP stimulation index was 31.3 ± 9.3 in the responders, and only 1.6 ± 0.3 in the non-responders (means ± s.e.m, P = 0.014). These Interest has focused on the function of the acute phase proteins in inflammation and malignancy. Of the latter proteins, C-reactive protein (CRP) has been identified as a sensitive, specific and rapidly responsive protein in serum (Weinstein et al., 1984). CRP has been shown to be induced by various malignancies, including different types of adenocarcinomas, and its level in serum to be elevated in patients with metastatic disease (Weinstein et al., 1984). We present preliminary data showing that CRP levels in serum may also be used as predictors of response to treatment with rIL2.
Materials and methodsFifteen patients with metastatic colorectal cancer were treated with rIL2 (18 x 106 IU m2 body surface area/24 h), by continuous intravenous infusion for a total of 120 h, combined with three pulses of 5-fluorouracil (600 mg/M2 body surface area), and folinic acid, (25 mg/M2 body surface area), also given intravenously at weekly intervals, starting 48 h after completing the rIL2 infusion. Prior to commencing any treatment, the concentrations of CRP were measured in the patients serum by rate nephelometry (Stemnberg, 1977), using a Beckman ICS Analyser II with Beckman reagents, calibrators and controls (CRP standardised against WHO CRP standard). The coefficient of variation for CRP measurements is 4% in our laboratory and the lower limit of the assay was 2 mg 1-. In addition, the serum concentrations of CRP during therapy were measured at 12 h, 24 h, 48 h, 72 h and 120 h after the commencement of the rIL2 infusions.The metastatic tumours were assessed by ultrasound, CT radiography and MRI scanning (4 weeks after the start of treatment and subsequently at monthly intervals). If the disease was static or had responded (partial response was defined as a reduction of greater than 50% in tumour measurements carried out in two perpendicular planes; complete response was no tumour detected by imaging modalities), further therapy was given, as described above, to a maximum of six cycles.The patients data was grouped into (i) responders (partial or complete) and (ii) non-responders (stasis or progression of disease), to treatment. The pre-treatment CRP levels were compared using Fischers exact test, and ...