An inflammation based score can optimize the selection of patients with advanced cancer considered for early phase clinical trials

Scarpa, A. et al. (2014) An inflammation based score can optimize the selection of patients with advanced cancer considered for early phase clinical trials. PLoS ONE, 9(1), e83279. (doi: 10.1371/journal.pone.0083279) (PMID:24409281) (PMCID:PMC3883636)

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Abstract

Background: Adequate organ function and good performance status (PS) are common eligibility criteria for phase I trials. As inflammation is pathogenic and prognostic in cancer we investigated the prognostic performance of inflammation-based indices including the neutrophil (NLR) and platelet to lymphocyte ratio (PLR). Methods: We studied inflammatory scores in 118 unselected referrals. NLR normalization was recalculated at disease reassessment. Each variable was assessed for progression-free (PFS) and overall survival (OS) on uni- and multivariate analyses and tested for 90 days survival (90DS) prediction using receiving operator curves (ROC). Results: We included 118 patients with median OS 4.4 months, 23% PS>1. LDH≥450 and NLR≥5 were multivariate predictors of OS (p<0.001). NLR normalization predicted for longer OS (p<0.001) and PFS (p<0.05). PS and NLR ranked as most accurate predictors of both 90DS with area under ROC values of 0.66 and 0.64, and OS with c-score of 0.69 and 0.60. The combination of NLR+PS increased prognostic accuracy to 0.72. The NLR was externally validated in a cohort of 126 subjects. Conclusions: We identified the NLR as a validated and objective index to improve patient selection for experimental therapies, with its normalization following treatment predicting for a survival benefit of 7 months. Prospective validation of the NLR is warranted.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:O'Cathail, Dr Sean
Authors: Scarpa, A., Pinato, D. J., Stavraka, C., Flynn, M. J., Forster, M. D., O'Cathail, S. M., Seckl, M. J., Kristeleit, R. S., Olmos, D., Turnbull, S. J., and Blagden, S. P.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cancer Sciences
Journal Name:PLoS ONE
Publisher:Public Library of Science
ISSN:1932-6203
ISSN (Online):1932-6203
Copyright Holders:Copyright © 2014 Pinato et al.
First Published:First published in PLoS ONE 9(1): e83279
Publisher Policy:Reproduced under a Creative Commons License

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