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