The prognostic role of inflammatory markers in patients with metastatic colorectal cancer treated with bevacizumab: A translational study [ASCENT]

Abstract

Background In spite of demonstrating prognostic and possibly predictive benefit in retrospective cohorts and meta-analyses of cancer populations, including colorectal cancer (CRC), prospective evaluation of the relationship between neutrophil to lymphocyte ratio (NLR) and treatment outcomes in previously untreated mCRC patients receiving bevacizumab-based therapy has not yet been performed. Methods An open-label, single arm, multi-centre study. Patients received first-line bevacizumab plus XELOX or mFOLFOX6 (Phase-A) and continued bevacizumab plus FOLFIRI beyond first progression (Phase-B). Analyses included the association of NLR with phase A progression free survival (PFS) and overall survival (OS). A sub-study investigated the safety in patients with the primary in situ tumor. An exploratory sub-study examined relationships of circulating proteomic markers with PFS. Results Phase-A enrolled 128 patients; median age was 64 years (range: 26-84), 70 (55%) were female, 71 (56%) were PS-0 and 51 (40%) had primary in situ tumor. Fifty-three (41%) patients entered Phase-B. The median baseline (b) NLR was 3.2 (range: 1.5-20.4) with 32

Tumor Microenvironment in Metastatic Colorectal Cancer: The Arbitrator in Patients’ Outcome

“…Moreover, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and systemic immune-inflammation index are predictors of good response of cetuximab-combined therapy in mCRC patients [ 91 ]. In line with these data, many studies confirm the neutrophil-lymphocyte ratio in mCRC under treatment options such as TAS-102 [ 92 ], first-line bevacizumab plus chemotherapy [ 93 , 94 ] and chemotherapy plus cetuximab [ 95 ]. Moreover, a high neutrophil-lymphocyte ratio also correlates with a cytokine profile relating to key biological processes involved in carcinogenesis that provides enhanced prognostic information [ 126 ].…”

Elevated serum neutrophil-lymphocyte ratio is associated with worse long-term survival in patients with HBV-related intrahepatic cholangiocarcinoma undergoing resection

“…This hypothesis has been extensively tested. Studies have shown that the inflammation marker NLR was associated with the prognosis of many solid tumours ( 10 – 18 ), especially in colorectal cancer, indicating that inflammation markers have important prognostic value ( 11 – 13 ). However, their role in liver cancer is not completely understood.…”

Intertwined leukocyte balances in tumours and peripheral blood as robust predictors of right and left colorectal cancer survival

“…A number of studies have stressed the importance of the systemic inflammatory response in CRC development and the search for variables involving its components as a valuable tool to drive prognosis[ 15 , 34 ]. Important prognostic records have been obtained in several research works[ 16 , 35 ], which avail the use of blood leukocyte ratios as predictors in CRC progression after surgery.…”