title: The aspartate aminotransferase to platelet ratio before chemotherapy predicts adverse events for FOLFOX and XELOX regimens including bevacizumab as the first-line therapy for stage IV, recurrent and metastatic colorectal cancer.
abstract: BACKGROUND
  Oxaliplatin-based chemotherapy for colorectal liver metastasis can induce hepatotoxicity, which increases the risk of liver resection. We previously reported that the aspartate aminotransferase to platelet ratio (APR) before chemotherapy can indicate oxaliplatin-induced splenomegaly and also predict the occurrence of adverse events during chemotherapy. Bevacizumab (BEV) was recently reported to reduce oxaliplatin-induced splenomegaly. Therefore, the aim of the present study was to investigate whether the APR before chemotherapy can predict the splenomegaly and adverse events associated with FOLFOX/BEV or XELOX/BEV in patients with stage IV or recurrent colorectal cancer.
  
  
  METHODS
  We performed CT volumetry of the spleen before and 12 weeks after FOLFOX/BEV and XELOX/BEV in 63 patients. The incidence of adverse events, haematological parameters, and biochemistry and urinalysis results were assessed during treatment.
  
  
  RESULTS
  An increase in the splenic volume was not observed in the FOLFOX/BEV group, but was significant in the XELOX/BEV group (+5.0% vs. +18.8%, P=0.01). The APR before chemotherapy did not indicate the presence of splenomegaly in the 63 patients, however, it did significantly predict the development of grade 2 or higher adverse events during chemotherapy.
  
  
  CONCLUSIONS
  An APR of 0.15 or higher before chemotherapy did not indicate the presence of splenomegaly, but could predict the development of adverse events due to FOLFOX/BEV and XELOX/BEV treatment.
authors.affiliation: Department of Surgery, Yokohama Asahi Central and General Hospital, 4-20-1 Wakabadai Asahi-ku Yokohama, 241-0801 Kanagawa, Japan;
authors.forename: Sumito
authors.initials: S
authors.lastname: Sato
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakano
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Ishida
authors.forename: Takehito
authors.initials: T
authors.lastname: Otsubo
keywords: Aspartate aminotransferase; chemotherapy; colorectal cancer; platelet; splenomegaly