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ePoster Display

467P - Monocyte to red blood cells ratio (MRR): an innovative haematologic prognostic parameter in FOLFIRI-aflibercept treated patients: A subgroup analysis from the DISTINCTIVE trial


16 Sep 2021


ePoster Display


Tumour Site

Colon and Rectal Cancer


Eleonora Lai


Annals of Oncology (2021) 32 (suppl_5): S530-S582. 10.1016/annonc/annonc698


E. Lai1, S. Murgioni2, P. Ziranu1, D. Basile3, S. Cherri4, C. Madeddu1, F. Bergamo2, G. Piacentini5, V. Smiroldo6, M. Squadroni7, M.C. De Grandis8, L. Mascia9, G. Rosati10, M.G. Zampino11, A. Spallanzani12, V. Conca13, M.A. Palladino14, V. Flaminio15, S. Di Bella16, M. Scartozzi1

Author affiliations

  • 1 Medical Oncology Unit, University Hospital and University of Cagliari, 09042 - Monserrato/IT
  • 2 Medical Oncology Unit 1, Department Of Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua/IT
  • 3 Department Of Oncology, San Bortolo General Hospital, Azienda ULSS8 Berica, Vicenza/IT
  • 4 Medical Oncology Unit, Fondazione Poliambulanza, Brescia/IT
  • 5 Oncologia Medica, Presidio Ospedaliero SS Antonio e Biagio e Cesare Arrigo, Alessandria/IT
  • 6 Medical Oncology And Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Milan/IT
  • 7 Oncologia Medica, Humanitas Gavazzeni Bergamo, Bergamo/IT
  • 8 1) Department Of Surgery, Oncology And Gastroenterology, 2) Medical Oncology Unit 1, Department Of Oncology, University of Padua; Veneto Institute of Oncology IOV - IRCCS, Padua/IT
  • 9 Medical Oncology Unit, Arnas G. Brotzu, ARNAS G. Brotzu, Ospedale Businco, Cagliari/IT
  • 10 U.o. Oncologia Medica, Ospedale S. Carlo, Potenza/IT
  • 11 Divisione Di Oncologia Medica Gastrointestinale E Tumori Neuroendocrini, Istituto Europeo di Oncologia-IRCCS Milan, Italy, Milan/IT
  • 12 Department Of Oncology And Haematology, Division Of Oncology, University Hospital of Modena, Modena/IT
  • 13 Unit Of Medical Oncology 2 Department Of Translational Research And New Technology In Medicine And Surgery, Azienda Ospedaliero-Universitaria Pisana; University of Pisa, Pisa/IT
  • 14 Oncology & Hematology Department, Oncology Unit, Piacenza General Hospital, Piacenza/IT
  • 15 Medical Oncology Unit, Internal Medicine Department "tor Vergata", "Tor Vergata" University Hospital, Rome/IT
  • 16 Alta Specialità Oncologia Medica, Uo Oncologia Medica, Asst Rhodense - Presidio Di Garbagnate, Italy, ASST Rhodense - Presidio di Garbagnate, Italy, Garbagnate Milanese/IT

Abstract 467P


Recently, laboratory parameters have been explored as potential prognostic biomarkers in several tumour types. Here we present our findings in the population enrolled in the interim analysis of the DISTINCTIVE trial (NCT04252456), a prospectively stratified, biologically enriched phase II study of second-line FOLFIRI-aflibercept in RAS wild type (wt) metastatic colorectal cancer (mCRC) patients (pts) progressing after first-line anti-epidermal growth factor receptor (EGFR) drugs.


RAS wt mCRC pts resistant to first-line oxaliplatin-based chemotherapy + anti-EGFR are administered second-line FOLFIRI-aflibercept. Primary endpoint is overall survival (OS) according to VEGFR2 levels, whereas secondary endpoints are OS, progression free survival (PFS), response rate, safety and angiogenic factors levels. Clinical and laboratory data are collected to evaluate their correlation with outcome. Statistical analysis is performed with MedCalc (survival distribution: Kaplan-Meier; survival comparison: log-rank test; cut off: ROC curves).


Of 73 pts enrolled from 04/2018 to 06/2020, 44 were eligible for interim analysis. Among the laboratory values assessed, monocytes (M), red blood cells (RBC) and M/RBC ratio (MRR) were of particular interest. Better OS was related to lower (≤0.7x103/μl) M (14.2 months [95%CI:10.4-14.2] vs 6.8 months [95%CI:0.5-6.8], HR 0.003, p=0.0002) and higher (>3.81x106/μl) RBC (14.2 months [95%CI:10.4-14.2] vs 6.8 months [95%CI:0.5-9.1], HR 0.005, p< 0.0001). Longer PFS was correlated with lower M (8.5 months [95% CI:5.3-24.2] vs 4.2 months [95%CI:3.9-5.8], HR 0.18, p=0.0266) and higher RBC (8.5 months [95%CI:5.7-24.2) vs 2.5 months [95%CI:2.1-4.2], HR 0.04, p=0.0007). Lower MRR (≤1528) was related to improved OS (14.2 months [95%CI:10.4-14.2] vs 6.8 months [95%CI:0.5-6.8], HR 0.004, p=0.0003) and PFS (8.5 months [95%CI:5.3-24.2] vs 4.2 months [95%CI:3.9-5.8], HR 0.24, p=0.0492).


Our analysis confirmed the prognostic role of some haematologic parameters and an innovative and easy-to assess ratio in RAS wt mCRC pts receiving FOLFIRI-aflibercept.

Clinical trial identification


Editorial acknowledgement

Legal entity responsible for the study

GISCAD (Gruppo Italiano per lo Studio dei Carcinomi dell'Apparato Digerente).


GISCAD; this study was partially supported by Sanofi Genzyme.


M. Scartozzi: Financial Interests, Personal, Advisory Board: Amgen; Sanofi; MSD; Eisai; Merck; Bayer; Financial Interests, Personal, Speaker’s Bureau: Amgen; Sanofi; MSD; Eisai; Merck; Bayer; Financial Interests, Personal, Other, Consultant: Amgen; Sanofi; MSD; Eisai; Merck; Bayer; All other authors have declared no conflicts of interest.

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