Open AccessLactate dehydrogenase kinetics predict chemotherapy response in recurrent metastatic nasopharyngeal carcinoma
Author(s) -
Luo Hy,
Adelene Y. L. Sim,
Yongzhong Wu,
ZhongGuo Liang,
Kaiguo Li,
Yongle Du,
Enya Hui Wen Ong,
Hong Qi Tan,
Joseph Wee,
Yue Xie,
Xiaolei Shu,
Ying Wang,
Melvin L.K. Chua,
XiaoDong Zhu
Publication year - 2020
Publication title -
therapeutic advances in medical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.272
H-Index - 49
eISSN - 1758-8359
pISSN - 1758-8340
DOI - 10.1177/1758835920970050
Subject(s) - medicine , lactate dehydrogenase , nasopharyngeal carcinoma , response evaluation criteria in solid tumors , chemotherapy , hazard ratio , progressive disease , biopsy , oncology , biomarker , gastroenterology , proportional hazards model , nuclear medicine , pathology , radiation therapy , confidence interval , enzyme , biology , biochemistry
Background: Lactate dehydrogenase (LDH) is a known prognostic biomarker for the endemic variant of nasopharyngeal carcinoma (NPC). Here, we investigate whether serial changes in LDH level between chemotherapy (CT) cycles are associated with tumour response to CT.Methods: Patients with biopsy-proven, recurrent or treatment-naïve metastatic NPC (mNPC) were recruited. All patients had received at least two cycles of platinum-based doublet or triplet CT, with serial assessment of LDH prior to every cycle of chemotherapy (CT1–6). Patients harbouring conditions that affect LDH levels (IU/L) were excluded. Tumour response was assessed after every two cycles of CT by RECIST v1.1.Results: A total of 158 patients were analysed, including 77 with recurrent and 81 with treatment-naïve mNPC. High pre-CT LDH was associated with an inferior overall survival [hazard ratio 1.93 for ⩾240 versus <240 (1.34–2.77), p < 0.001], which is consistent with published literature. We found that both absolute LDH levels and LDH ratios (LDH CTn : LDH CTn–1 ) were associated with tumour response [partial response versus progressive disease: median value across CT1–6 = 168–190 versus 222–398 (absolute); 0.738–0.988 versus 1.039–1.406 (ratio)], albeit LDH ratio had a tighter variance between patients. Finally, we showed that an LDH ratio cut-off of 1.0 at CT1, CT3 and CT5 was predictive of progressive disease at CT2, CT4, CT6 [area under the curve of 0.73 (0.65–0.80)].Conclusion: Herein, we characterised the longitudinal variation of LDH in response to CT in mNPC. Our findings suggest the potential utility of interval LDH ratio to predict subsequent tumour response to CT.