The value of lactate dehydrogenase serum levels as a prognostic and predictive factor for advanced pancreatic cancer patients receiving sorafenib

// Luca Faloppi 1 , Maristella Bianconi 1 , Riccardo Giampieri 1 , Alberto Sobrero 2 , Roberto Labianca 3 , Daris Ferrari 4 , Sandro Barni 5 , Enrico Aitini 6 , Alberto Zaniboni 7 , Corrado Boni 8 , Francesco Caprioni 2 , Stefania Mosconi 3 , Silvia Fanello 8 , Rossana Berardi 1 , Alessandro Bittoni 1 , Kalliopi Andrikou 1 , Michela Cinquini 9 , Valter Torri 9 , Mario Scartozzi 10 , Stefano Cascinu 1 , on behalf of the Italian Group for the Study of Digestive Tract Cancer (GISCAD) 1 Medical Oncology Unit, Università Politecnica delle Marche, AOU “Ospedali Riuniti”, Ancona, Italy 2 Medical Oncology Unit, Ospedale S. Martino, Genova, Italy 3 Medical Oncology Unit, Ospedali Riuniti, Bergamo, Italy 4 Medical Oncology Unit, Ospedale S. Paolo, Milano, Italy 5 Medical Oncology Unit, Treviglio Hospital, Treviglio, Italy 6 Medical Oncology Unit, C. Poma Hospital, Mantova, Italy 7 Medical Oncology Unit, Fondazione Poliambulanza, Brescia, Italy 8 Medical Oncology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy 9 New Drug Development Strategies Laboratory, Mario Negri Institute, Milano, Italy 10 Medical Oncology Unit, Università degli Studi di Cagliari, Azienda Ospedaliero Universitaria, Cagliari, Italy Correspondence to: Stefano Cascinu, e-mail: cascinu@yahoo.com Keywords: pancreatic cancer, lactate dehydrogenase, angiogenesis, sorafenib, TKI Received: May 22, 2015 Accepted: August 28, 2015 Published: September 10, 2015 ABSTRACT Although lactate dehydrogenase (LDH) serum levels, indirect markers of angiogenesis, are associated with a worse outcome in several tumours, their prognostic value is not defined in pancreatic cancer. Moreover, high levels are associated even with a lack of efficacy of tyrosine kinase inhibitors, contributing to explain negative results in clinical trials. We assessed the role of LDH in advanced pancreatic cancer receiving sorafenib. Seventy-one of 114 patients included in the randomised phase II trial MAPS (chemotherapy plus or not sorafenib) and with available serum LDH levels, were included in this analysis. Patients were categorized according to serum LDH levels (LDH ≤vs.> upper normal rate). A significant difference was found in progression free survival (PFS) and in overall survival (OS) between patients with LDH values under or above the cut-off (PFS: 5.2 vs. 2.7 months, p = 0.0287; OS: 10.7 vs. 5.9 months, p = 0.0021). After stratification according to LDH serum levels and sorafenib treatment, patients with low LDH serum levels treated with sorafenib showed an advantage in PFS ( p = 0.05) and OS ( p = 0.0012). LDH appears to be a reliable parameter to assess the prognosis of advanced pancreatic cancer patients, and it may be a predictive parameter to select patients candidate to receive sorafenib.