Open AccessPretreatment Neutrophil‐to‐Lymphocyte Ratio in Metastatic Castration‐Resistant Prostate Cancer Patients Treated With Ketoconazole: Association with Outcome and Predictive Nomogram
Author(s) -
Keizman Daniel,
Gottfried Maya,
IshShalom Maya,
Maimon Natalie,
Peer Avivit,
Neumann Avivit,
Rosenbaum Eli,
Kovel Svetlana,
Pili Roberto,
Sinibaldi Victoria,
Carducci Michael A.,
Hammers Hans,
Eisenberger Mario A.,
Sella Avishay
Publication year - 2012
Publication title -
the oncologist
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.176
H-Index - 164
eISSN - 1549-490X
pISSN - 1083-7159
DOI - 10.1634/theoncologist.2012-0125
Subject(s) - medicine , nomogram , ketoconazole , prostate cancer , oncology , neutrophil to lymphocyte ratio , androgen deprivation therapy , enzalutamide , prostate specific antigen , urology , cancer , lymphocyte , androgen receptor , antifungal , dermatology
Background. The neutrophil‐to‐lymphocyte ratio (NLR), an inflammation marker, is prognostic in several cancers. We assessed the association between the pretreatment NLR and outcome of patients with metastatic castration‐resistant prostate cancer (mCRPC) treated with the CYP17 inhibitor ketoconazole. Methods. This was an international, retrospective study of 156 mCRPC patients treated with ketoconazole. The independent effect of the pretreatment NLR and factors associated with treatment outcome were determined by multivariate analysis. Results. Seventy‐eight patients (50%) had a ≥50% decline in prostate‐specific antigen (PSA). The median progression‐free survival (PFS) time was 8 months. Excluded from the analysis were 23 patients without available data on their NLR and those with a recent health event or treatment associated with a blood count change. Sixty‐two patients (47%) had a pretreatment NLR >3. Risk factors associated with the PFS outcome were a pretreatment NLR >3 and PSA doubling time (PSADT) <3 months and a prior response to a gonadotropin‐releasing hormone agonist of <24 months or to an antiandrogen of <6 months. The number of risk factors was used to form a predictive nomogram by patient categorization into favorable (zero or one factor), intermediate (two factors), and poor (three or four factors) risk groups. Conclusions. In mCRPC patients treated with ketoconazole, the pretreatment NLR and PSADT, and prior response to androgen‐deprivation therapy, may be associated with the PFS time and used to form a risk stratification predictive nomogram.