title: Persistent Neutrophil to Lymphocyte Ratio >3 during Treatment with Enzalutamide and Clinical Outcome in Patients with Castration-Resistant Prostate Cancer.
abstract: The baseline value of neutrophil to lymphocyte ratio (NLR) has been found to be prognostic in patients with metastatic castration resistant prostate cancer (CRPC). We evaluated the impact of baseline NLR and its change in patients receiving enzalutamide. We included consecutive metastatic CRPC patients treated with enzalutamide after docetaxel and studies the change of NLR (>3 vs ≤3) after week 4 and 12 weeks. Progression-free survival (PFS), overall survival (OS) and their 95% Confidence Intervals (95% CI) were estimated by the Kaplan-Meier method and compared with the log-rank test. The impact of NLR on PFS and OS was evaluated by Cox regression analyses and on prostate-specific antigen response rates (PSA RR; PSA decline >50%) were evaluated by binary logistic regression. Data collected on 193 patients from 9 centers were evaluated. Median age was 73.1 years (range, 42.8-90.7). The median baseline NLR was 3.2. The median PFS was 3.2 months (95% CI = 2.7-4.2) in patients with baseline NLR >3 and 7.4 months (95% CI = 5.5-9.7) in those with NLR ≤3, p < 0.0001. The median OS was 10.4 months (95% CI = 6.5-14.9) in patients with baseline NLR >3 and 16.9 months (95% CI = 11.2-20.9) in those with baseline NLR ≤3, p < 0.0001. In multivariate analysis, changes in NLR at 4 weeks were significant predictors of both PFS [hazard ratio (HR) 1.24, 95% confidence interval (95% CI) 1.07-1.42, p = 0.003, and OS (HR 1.29, 95% CI 1.10-1.51, p = 0.001. A persistent NLR >3 during treatment with enzalutamide seems to have both prognostic and predictive value in CRPC patients.
authors.affiliation: Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy.
authors.forename: Vincenza
authors.initials: V
authors.lastname: Conteduca
authors.affiliation: Cancer Sciences Unit, University of Southampton, Southampton, United Kingdom.
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Crabb
authors.affiliation: Institute of Cancer Sciences, University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Jones
authors.affiliation: Medical Oncology Department - Santa Chiara Hospital, Trento, Italy.
authors.forename: Orazio
authors.initials: O
authors.lastname: Caffo
authors.affiliation: Christie Hospital, Manchester, United Kingdom.
authors.forename: Tony
authors.initials: T
authors.lastname: Elliott
authors.affiliation: Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Scarpi
authors.affiliation: Oncology Unit, Cervesi Hospital, Cattolica, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Fabbri
authors.affiliation: Medical Oncology Department - Santa Chiara Hospital, Pisa, Italy.
authors.forename: Lisa
authors.initials: L
authors.lastname: Derosa
authors.affiliation: Institut Gustave Roussy, Villejuif, France.
authors.forename: Francesco
authors.initials: F
authors.lastname: Massari
authors.affiliation: Medical Oncology and Hematology, Azienda USL della Valle d'Aosta, Aosta, Italy.
authors.forename: Gianmauro
authors.initials: G
authors.lastname: Numico
authors.affiliation: Cancer Sciences Unit, University of Southampton, Southampton, United Kingdom.
authors.forename: Sunnya
authors.initials: S
authors.lastname: Zarif
authors.affiliation: Institute of Cancer Sciences, University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom.
authors.forename: Catherine
authors.initials: C
authors.lastname: Hanna
authors.affiliation: Medical Oncology Department - Santa Chiara Hospital, Trento, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Maines
authors.affiliation: Christie Hospital, Manchester, United Kingdom.
authors.forename: Helen
authors.initials: H
authors.lastname: Joyce
authors.affiliation: Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy.
authors.forename: Cristian
authors.initials: C
authors.lastname: Lolli
authors.affiliation: Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy.
authors.forename: Ugo
authors.initials: U
authors.lastname: De Giorgi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001549:Benzamides; D018572:Disease-Free Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D008214:Lymphocytes / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000187:drug effects; D009570:Nitriles; D010669:Phenylthiohydantoin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D011379:Prognosis; D064129:Prostatic Neoplasms, Castration-Resistant / Q000097:blood* / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D001549:Benzamides; D009570:Nitriles; D010669:Phenylthiohydantoin; C540278:enzalutamide