Abiraterone [Zytiga] & the Neutrophil-to-Lymphocyte Ratio [NLR]

New German study below.

A month ago I posted a series on inflammation & mortality, starting with:

"Inflammation. [1] Neutrophil-to-Lymphocyte Ratio [NLR]"

The NLR is a measure of inflammation. Lower is better. In fact, much lower than the 5 used as a cutoff here.

"The impact of baseline NLR and change after eight weeks of treatment on progression-free survival (PFS) and overall survival (OS) was analyzed ..." "79 men with baseline NLR <5 and 17 with NLR >5"

"NLR >5 was associated with ... shorter median {progression-free survival} (five versus 10 months)"

"For {overall survival}, NLR >5 was associated with shorter survival (seven versus 19 months)"

"We concluded baseline NLR <5 is associated with improved survival."

Oddly: "In contrast, in patients with baseline NLR >5, NLR-change to <5 after eight weeks of Abiraterone was associated with worse survival and should be interpreted carefully."

Reducing inflammation will always improve survival prospects. The reduction in NLR in some men with NLR > 5 seems not to have been due to control of inflammation.

NLR is a useful number, but one should not rely on one indicator of inflammation. Combine it with albumin & CRP, say.

-Patrick

ncbi.nlm.nih.gov/pubmed/282...

Int J Mol Sci. 2017 Feb 11;18(2). pii: E380. doi: 10.3390/ijms18020380.

The Role of the Neutrophil to Lymphocyte Ratio for Survival Outcomes in Patients with Metastatic Castration-Resistant Prostate Cancer Treated with Abiraterone.

Boegemann M1, Schlack K2, Thomes S3, Steinestel J4, Rahbar K5, Semjonow A6, Schrader AJ7, Aringer M8, Krabbe LM9,10.

Author information

1Department of Urology, Prostate Center, University Hospital Muenster, Albert-Schweitzer-Campus 1, GB A1, D-48149 Muenster, Germany. martin.boegemann@ukmuenster.de.

2Department of Urology, Prostate Center, University Hospital Muenster, Albert-Schweitzer-Campus 1, GB A1, D-48149 Muenster, Germany. katrin.schlack@ukmuenster.de.

3Department of Urology, Prostate Center, University Hospital Muenster, Albert-Schweitzer-Campus 1, GB A1, D-48149 Muenster, Germany. s_thom09@uni-muenster.de.

4Department of Urology, Prostate Center, University Hospital Muenster, Albert-Schweitzer-Campus 1, GB A1, D-48149 Muenster, Germany. Julie.steinestel@ukmuenster.de.

5Department of Nuclear Medicine, Muenster University Medical Center, Albert-Schweitzer-Campus 1, GB A1, D-48149 Muenster, Germany. kambiz.rahbar@ukmuenster.de.

6Department of Urology, Prostate Center, University Hospital Muenster, Albert-Schweitzer-Campus 1, GB A1, D-48149 Muenster, Germany. axel.semjonow@ukmuenster.de.

7Department of Urology, Prostate Center, University Hospital Muenster, Albert-Schweitzer-Campus 1, GB A1, D-48149 Muenster, Germany. andresjan.schrader@ukmuenster.de.

8Department of Rheumatology, Dresden University Medical Center, Fetscherstraße 74, D-01307 Dresden, Germany. martin.aringer@uniklinikum-dresden.de.

9Department of Urology, Prostate Center, University Hospital Muenster, Albert-Schweitzer-Campus 1, GB A1, D-48149 Muenster, Germany. laura-maria.krabbe@ukmuenster.de.

10Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9110, USA. laura-maria.krabbe@ukmuenster.de.

Abstract

The purpose of this study was to examine the prognostic capability of baseline neutrophil-to-lymphocyte-ratio (NLR) and NLR-change under Abiraterone in metastatic castration-resistant prostate cancer patients. The impact of baseline NLR and change after eight weeks of treatment on progression-free survival (PFS) and overall survival (OS) was analyzed using Kaplan-Meier-estimates and Cox-regression. 79 men with baseline NLR <5 and 17 with NLR >5 were analyzed. In baseline analysis of PFS NLR >5 was associated with non-significantly shorter median PFS (five versus 10 months) (HR: 1.6 (95%CI:0.9-2.8); p = 0.11). After multivariate adjustment (MVA), ECOG > 0-1, baseline LDH>upper limit of normal (UNL) and presence of visceral metastases were independent prognosticators. For OS, NLR >5 was associated with shorter survival (seven versus 19 months) (HR: 2.3 (95%CI:1.3-4.0); p < 0.01). In MVA, ECOG > 0-1 and baseline LDH > UNL remained independent prognosticators. After 8 weeks of Abiraterone NLR-change to <5 prognosticated worse PFS (five versus 12 months) (HR: 4.1 (95%CI:1.1-15.8); p = 0.04). MVA showed a trend towards worse PFS for NLR-change to <5 (p = 0.11). NLR-change to <5 led to non-significant shorter median OS (seven versus 16 months) (HR: 2.3 (95%CI:0.7-7.1); p = 0.15). MVA showed non-significant difference for OS. We concluded baseline NLR <5 is associated with improved survival. In contrast, in patients with baseline NLR >5, NLR-change to <5 after eight weeks of Abiraterone was associated with worse survival and should be interpreted carefully.

KEYWORDS:

abiraterone; castration-resistant prostate cancer; neutrophil-to-lymphocyte ratio; prognostic biomarker; treatment response

PMID: 28208664 DOI: 10.3390/ijms18020380

[PubMed - in process]

4 Replies

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  • Patrick, any mention on how one can lower the NLR ratio (other than taking Zytiga)?

  • Len,

    With all of these markers of subclinical inflammation, it comes down to inhibiting NF-kB. NF-kB is chronically activated in PCa. There are many polyphenols that inhibit NF-kB.

    In my posts on inflammation I suggest taking a handful of polyphenols at levels that modify markers (easily monitored). They are well-tolerated, generally.

    My albumin was 3.9 12 years ago, & 4.6 when last tested.

    It's a bit strange to be telling people to tackle inflammation, when they want to know about tackling cancer, but inflammation is just one aspect of NF-kB activation. If inflammation can be controlled, we take the fire out of the cancer.

    -Patrick

  • Ok, polyphenols, so basically, eat your fruits and vegetables and drink a glass of red wine, i.e., follow the Mediterranean diet.

  • I was thinking of higher doses, but diet can help. The usual stuff: curcumin, resveratrol & so on.

    www98.griffith.edu.au/dspac...

    -Patrick

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