Inflammatory biomarkers in metastatic colorectal cancer: prognostic and predictive role beyond the first line setting

// Jakob Michael Riedl 1 , Florian Posch 1 , Florian Moik 1 , Angelika Bezan 1 , Joanna Szkandera 1 , Maria Anna Smolle 1 , Anne-Katrin Kasparek 1 , Martin Pichler 1, 3 , Herbert Stöger 1 , Michael Stotz 1 and Armin Gerger 1, 2 1 Division of Clinical Oncology, Department of Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, 8036 Graz, Austria 2 Center for Biomarker Research in Medicine, 8010 Graz, Austria 3 Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA Correspondence to: Michael Stotz, email: michael.stotz@medunigraz.at Keywords: biomarker, inflammation, metastatic, colorectal cancer, palliative chemotherapy Received: July 05, 2017 Accepted: August 08, 2017 Published: October 04, 2017 ABSTRACT Introduction: Inflammatory biomarkers are useful prognostic tools in cancer patients. However, the prognostic and predictive value of inflammatory biomarkers beyond the 1 st -line setting in metastatic colorectal cancer (mCRC) is unclear. Results: In multivariate analysis 1 standard deviation increase in neutrophil-lymphocyte-ratio (NLR) was associated with an 8.5% absolute lower objective-response-rate (ORR) in 1 st -line (p nd -line (p rd -line (p=0.24), respectively. Regarding progression free survival (PFS), an increase in the NLR was significantly associated with rising hazard-ratios (HR) over all treatment lines (HR=1.30, p= 0.021 1 st -line); (HR=1.37, p nd -line); (HR=1.44, p=0.042 3 rd -line). The platelet-lymphocyte-ratio (PLR) was associated with 6-month PFS over all three treatment lines. Higher C-reactive-protein (CRP) predicted for worse PFS in the first two chemotherapy lines and in best supportive care (BSC). (HR=1.49 (p st -line); HR=1.25 (p=0.007 2 nd -line); HR=1.09 (95%CI 0.81–1.48, p=0.552 3 rd -line and HR=1.43 (p= 0.002 in BSC)). Methods: Two-hundred-fifty-eight patients with mCRC undergoing palliative chemo(immuno-)therapy were retrospectively included. Primary endpoints were 6-month PFS and ORR during 1st-line, 2nd-line, and 3rd-line treatment, and 6-month overall survival during BSC. Conclusion: This study shows that inflammatory biomarkers are useful predictors of disease outcome and treatment response over several treatment lines in mCRC patients.