Prognostic clinical factors in pretreated colorectal cancer patients receiving regorafenib: Implications for clinical management

// Michela Del Prete 1 , Riccardo Giampieri 1 , Fotios Loupakis 3 , Tiziana Prochilo 2 , Lisa Salvatore 3 , Luca Faloppi 1 , Maristella Bianconi 1 , Alessandro Bittoni 1 , Giuseppe Aprile 4 , Alberto Zaniboni 2 , Alfredo Falcone 3 , Mario Scartozzi 5 , Stefano Cascinu 1 1 Medical Oncology, AO Ospedali Riuniti-Università Politecnica delle Marche, 60126 Ancona, Italy 2 Medical Oncology, Fondazione Poliambulanza, 25124 Brescia, Italy 3 Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy 4 Medical Oncology, Azienda Ospedaliero-Universitaria “S. Maria della Misericordia”, 33100 Udine, Italy 5 Medical Oncology, Azienda Ospedaliero-Universitaria di Cagliari, 09042 Monserrato (CA), Cagliari, Italy Correspondence to: Mario Scartozzi, e-mail: marioscartozzi@gmail.com Keywords: regorafenib, colorectal cancer, prognostic factors, LDH, neutrophil/lymphocyte ratio Received: June 26, 2015      Accepted: August 04, 2015      Published: August 17, 2015 ABSTRACT Background: We assessed the impact on survival of angiogenesis and inflammation-related factors, particularly LDH serum levels, platelet, neutrophil and lymphocyte counts, and neutrophil-to-lymphocyte ratio (NLR), in metastatic colorectal cancer patients receiving regorafenib monotherapy. Methods: LDH serum levels, neutrophil, lymphocyte and platelet counts were collected at the start of regorafenib monotherapy. Cut-off values were calculated by ROC curve analysis. Survival analyses were performed by Kaplan-Meier method, and multivariate analysis by Cox method. Results: A total of 208 patients were eligible for analysis. Among factors who were related with worse overall survival and who maintained their role at the multivariate analysis, high platelet count (Exp(b):1.4963, 95% CI:1.0130–2.2103, p = 0.0439) and high neutrophil/lymphocyte ratio (Exp(b):1.6963, 95% CI:1.0757–2.6751, p = 0.0237) were those who more deeply were related to worse overall survival. High lymphocyte count (Exp(b):0.4527, 95% CI:0.2801–0.7316, p = 0.0013) was correlated with improved overall survival. Conclusions: High neutrophil, high platelet, low lymphocyte count and/or high NLR may represent negative prognostic factors in patients receiving regorafenib monotherapy. It is advisable that these factors are taken into account in the design of subsequent trials in colorectal cancer patients receiving this drug.