Neutrophil to Lymphocyte Ratio, Xtandi, & Outcome in CRPC

[pjoshea13]

New study below [1].

I must have written more posts on inflammation than anything else.

I expect that, on any cancer site, few would pay attention to a post on inflammation. It's not cancer-specific. But it is very much survival-specific.

The Neutrophil to Lymphocyte Ratio {NLR}, which is reported on most basic blood panels, is a measure of subclinical inflammation.

"We included consecutive metastatic CRPC patients treated with enzalutamide after docetaxel"

"Data collected on 193 patients from 9 centers were evaluated."

"The median baseline NLR was 3.2."

"The median {overall survival} was 10.4 months ... in patients with baseline NLR >3 and 16.9 months ... in those with baseline NLR ≤3"

"In multivariate analysis, changes in NLR at 4 weeks were significant predictors of both {Progression-free survival} [hazard ratio (HR) 1.24 ..., and {overall survival} (HR 1.29 ...)"

"A persistent NLR >3 during treatment with enzalutamide seems to have both A persistent NLR >3 during treatment with enzalutamide seems to have both prognostic and predictive value in CRPC patients. value in CRPC patients."

It's all very well to write about "prognostic and predictive value", but inflammation can be reversed.

There are now 45 PubMed hits for <prostate Neutrophil Lymphocyte Ratio>, but are doctors paying attention?

The most recent Review and Meta-Analysis came out in April [2]:

"The present meta-analysis indicated that the inflammation marker NLR had prognostic values for OS {overall survival } and RFS {recurrence-free survival} in patients with PCa. Although high pretreatment NLR had a significant prognostic value in patients with advanced PCa, such NLR had no predictive value in terms of OS in patients with localized PCa. Therefore, higher pretreatment NLR had a stronger predictive effect in patients with more advanced disease. In terms of RFS, patients with higher pretreatment NLR had shorter RFS than those with lower NLR in both localized and advanced PCa; however, the association was more significant in patients with advanced PCa. Two previous studies in patients with colorectal and lung cancers also concluded that the prognostic value of NLR was higher in more advanced cancers"

-Patrick

[1] ncbi.nlm.nih.gov/pubmed/274...

[2] journals.plos.org/plosone/a...

[hadleycash]

Fascinating... so what can be done to lower the ratio?

[pjoshea13 in reply to hadleycash]

Anything that inhibits PCa cells from activating NF-kB.

Tom Gilmore, at the Gilmore Lab at Boston University, maintains a NF-kB site. Here's the page for:

"Antioxidants that have been shown to inhibit activation of NF-kB"

bu.edu/nf-kb/table-1/

Basically, any plant polyphenol with a PCa literature showing, should be considered. Curcumin, apigenin, resveratrol, pomegranate & a dozen other common phytochemicals are contenders. Use a mix & back into a dose that shows results. (Don't use a-Lipoic acid.)

Other inflammation markers to monitor:

- albumin - should be >=4.5

- C-Reactive Protein - should be as close to zero as possible. Most of the reference range is too high

- Fibrinogen - should be low-normal

- etc.

-Patrick

[BigRich in reply to pjoshea13]

Patrick,

I see this post answered my earlier question to you. Excuse, its 6:48 AM and I have not gone to sleep yet.

Rich

[joeoconnell]

does anyone know of a good cryptographer?

[Hidden]

huh? Neutrophil=54% / Lympocyte=32% = 1.77

To get to 3.0, neutrophils would have to be 96% or lymphocytes to 18% (?)

[pjoshea13]

But they are not independent variables. A 30% shift in both would get you above 3.0. e.g. 70/22. & then there is the simple example of 75/25. I don't know what actual cases look like, though.

-Patrick