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Is baseline neutrophil to lymphocyte ratio (NLR) an independent prognostic biomarker for progression free survival (PFS) and overall survival (OS) in metastatic colorectal cancer (mCRC)? Analysis of the AGITG MAX study

Date

08 Oct 2016

Session

Poster Display

Presenters

Connie Diakos

Citation

Annals of Oncology (2016) 27 (6): 149-206. 10.1093/annonc/mdw370

Authors

C.I. Diakos1, K. Wilson2, R. Asher2, V. Gebski2, S. Yip2, G. van Hazel3, B. Robinson4, A. Broad5, T.J. Price6, J. Simes7, N. Tebbutt8, S. Clarke9

Author affiliations

  • 1 Kolling Institute Of Medical Research, Royal North Shore Hospital, 2065 - St Leonards/AU
  • 2 Nhmrc Clinical Trials Centre, NHMRC Clinical Trials Centre University of Sydney, 2050 - Camperdown/AU
  • 3 School Of Medicine And Pharmacology, University of Western Australia, Perth/AU
  • 4 Oncology Service, Christchurch Hospital, Christchurch/NZ
  • 5 Medical Oncology, Andrew Love Cancer Centre, 3220 - Geelong/AU
  • 6 Haematology And Oncology, The Queen Elizabeth Hospital and University of Adelaide, 5011 - Adelaide/AU
  • 7 Oncology, NHMRC Clinical Trials Centre, Sydney/AU
  • 8 Medical Oncology, Austin Hospital, 3084 - Heidelberg/AU
  • 9 Medical Oncology, Royal North Shore Hospital, 2065 - St Leonards/AU
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Resources

Background

NLR (ratio of absolute neutrophil and lymphocyte counts) has shown prognostic utility for OS in a number of cancer types. The AGITG MAX study examined capecitabine (C) with C + bevacizumab (B) and C + B + mitomycin C (M) in first-line treatment of mCRC. CB demonstrated superiority over C for PFS and was comparable to CBM. We examine NLR in the MAX study to assess its utility for prediction of treatment effect, PFS and OS.

Methods

PFS and OS estimates were obtained using the method of Kaplan-Meier and hazard ratios obtained using proportional hazards models. Analysis included adjusting for baseline (BL) disease and patient (pt) characteristics and investigating potential interaction effects between NLR status and significant BL predictors of outcome.

Results

MAX study recruited 471 pts; relevant BL haematological data was available for 403 pts (86%). At BL, 24% of pts had high NLR (≥5). High NLR correlated with rectal primary (p = 0.007), higher ECOG status (p 

Conclusions

NLR provides independent prognostic information for patients with mCRC receiving first-line treatment in the MAX study, for both PFS and OS. This should become a standard stratification indication for future randomised controlled trials.

Clinical trial identification

ANZ Clinical Trial Registry ACTRN12605000025639

Legal entity responsible for the study

Australian Gastro-Intestinal Trials Group

Funding

Lead sponsor: Australian Gastro-Intestinal Trials Group. Funder: Roche.

Disclosure

C.I. Diakos: Ipsen Advisory Board, November 2015 & April 2016. V. Gebski: Honoraria: Sirtex. Consultancy: Sirtex. Travel support: Sirtex. A. Broad: Roche Advisory Board. T.J. Price: Merck Advisory Board. N. Tebbutt: Advisory Board Roche, Merck Serono. S. Clarke: Advisory Board Roche, Merck. All other authors have declared no conflicts of interest.

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