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Impact of Pre-Treatment Lactate Dehydrogenase Levels on Prognosis and Bevacizumab Efficacy in Patients with Metastatic Colorectal Cancer.

Passardi A, Scarpi E, Tamberi S, Cavanna L, Tassinari D, Fontana A, Pini S, Bernardini I, Accettura C, Ulivi P, Frassineti GL, Amadori D - PLoS ONE (2015)

Bottom Line: High LDH levels were predictive of a lower median PFS (8.1 months vs. 9.2 months, p< 0.0001) and median OS (16.1 months vs. 25.2 months, p< 0.0001) in the overall population.A high LDH value was confirmed as a marker of poor prognosis.Bevacizumab reduced the progressive disease rate and improved PFS in the high-LDH subgroup, making serum LDH a potentially effective an easily available and marker to select patients who benefit from bevacizumab.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy.

ABSTRACT

Background: To investigate the impact of pre-treatment lactate dehydrogenase (LDH) levels on the outcome of patients with metastatic colorectal cancer treated with first-line chemotherapy with or without the anti-VEGF monoclonal antibody, bevacizumab, in a phase III prospective multicentre randomized ITACa (Italian Trial in Advanced Colorectal Cancer) trial.

Methods: Three hundred and seventy patients enrolled onto the ITACa first-line trial were considered for this study, 176 receiving chemotherapy (either FOLFIRI or FOLFOX) plus bevacizumab and 194 receiving chemotherapy only. Pre-treatment LDH levels were evaluated to identify a potential correlation with progression-free survival (PFS), overall survival (OS) and objective response rate.

Results: Information on pre-treatment LDH levels was available for 344 patients. High LDH levels were predictive of a lower median PFS (8.1 months vs. 9.2 months, p< 0.0001) and median OS (16.1 months vs. 25.2 months, p< 0.0001) in the overall population. In the chemotherapy plus bevacizumab group, median PFS was 9.1 and 9.8 months in patients with high LDH and low LDH, respectively (p= 0.073), whereas in the chemotherapy-only arm it was 6.9 and 9.1 months, respectively (p < 0.0001). In patients with high LDH, the addition of bevacizumab to chemotherapy led to a reduction in the rate of progressive disease (16.4 vs. 30.5%, p= 0.081) and to a prolonged PFS (p= 0.028).

Conclusion: A high LDH value was confirmed as a marker of poor prognosis. Bevacizumab reduced the progressive disease rate and improved PFS in the high-LDH subgroup, making serum LDH a potentially effective an easily available and marker to select patients who benefit from bevacizumab.

Trial registration: NCT01878422 ClinicalTrials.gov.

No MeSH data available.


Related in: MedlinePlus

PFS and OS according to LDH in CT+B and CT only arms.
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pone.0134732.g003: PFS and OS according to LDH in CT+B and CT only arms.

Mentions: Our results go in the same direction. Among patients randomized to CT only, LDH was confirmed as a marker of poor prognosis as high levels were associated with significantly worse PFS (adjusted [adj] HR 1.37, 95% CI 1.07–1.76, p = 0.013) and OS (adj HR 1.55, 95% CI 1.18–2.04, p = 0.002). LDH maintained the same prognostic value in the cohort of patients treated with CT alone in whom high LDH levels were correlated with lower PFS (adj HR 1.64, 95% CI 1.15–2.34, p = 007) and OS (adj HR 1.92, 95% CI 1.30–2.83, p = 0.001). The addition of B to CT appears to have reversed this trend, and high LDH patients in the CT+B arm had a median PFS and OS similar to those with low LDH (adj HR 1.06, 95% CI 0.73–1.53 and 1.18, 95% CI 0.78–1.79, p = 0.759 and 0.428, respectively) (Table 3, Fig 3).


Impact of Pre-Treatment Lactate Dehydrogenase Levels on Prognosis and Bevacizumab Efficacy in Patients with Metastatic Colorectal Cancer.

Passardi A, Scarpi E, Tamberi S, Cavanna L, Tassinari D, Fontana A, Pini S, Bernardini I, Accettura C, Ulivi P, Frassineti GL, Amadori D - PLoS ONE (2015)

PFS and OS according to LDH in CT+B and CT only arms.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4526665&req=5

pone.0134732.g003: PFS and OS according to LDH in CT+B and CT only arms.
Mentions: Our results go in the same direction. Among patients randomized to CT only, LDH was confirmed as a marker of poor prognosis as high levels were associated with significantly worse PFS (adjusted [adj] HR 1.37, 95% CI 1.07–1.76, p = 0.013) and OS (adj HR 1.55, 95% CI 1.18–2.04, p = 0.002). LDH maintained the same prognostic value in the cohort of patients treated with CT alone in whom high LDH levels were correlated with lower PFS (adj HR 1.64, 95% CI 1.15–2.34, p = 007) and OS (adj HR 1.92, 95% CI 1.30–2.83, p = 0.001). The addition of B to CT appears to have reversed this trend, and high LDH patients in the CT+B arm had a median PFS and OS similar to those with low LDH (adj HR 1.06, 95% CI 0.73–1.53 and 1.18, 95% CI 0.78–1.79, p = 0.759 and 0.428, respectively) (Table 3, Fig 3).

Bottom Line: High LDH levels were predictive of a lower median PFS (8.1 months vs. 9.2 months, p< 0.0001) and median OS (16.1 months vs. 25.2 months, p< 0.0001) in the overall population.A high LDH value was confirmed as a marker of poor prognosis.Bevacizumab reduced the progressive disease rate and improved PFS in the high-LDH subgroup, making serum LDH a potentially effective an easily available and marker to select patients who benefit from bevacizumab.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy.

ABSTRACT

Background: To investigate the impact of pre-treatment lactate dehydrogenase (LDH) levels on the outcome of patients with metastatic colorectal cancer treated with first-line chemotherapy with or without the anti-VEGF monoclonal antibody, bevacizumab, in a phase III prospective multicentre randomized ITACa (Italian Trial in Advanced Colorectal Cancer) trial.

Methods: Three hundred and seventy patients enrolled onto the ITACa first-line trial were considered for this study, 176 receiving chemotherapy (either FOLFIRI or FOLFOX) plus bevacizumab and 194 receiving chemotherapy only. Pre-treatment LDH levels were evaluated to identify a potential correlation with progression-free survival (PFS), overall survival (OS) and objective response rate.

Results: Information on pre-treatment LDH levels was available for 344 patients. High LDH levels were predictive of a lower median PFS (8.1 months vs. 9.2 months, p< 0.0001) and median OS (16.1 months vs. 25.2 months, p< 0.0001) in the overall population. In the chemotherapy plus bevacizumab group, median PFS was 9.1 and 9.8 months in patients with high LDH and low LDH, respectively (p= 0.073), whereas in the chemotherapy-only arm it was 6.9 and 9.1 months, respectively (p < 0.0001). In patients with high LDH, the addition of bevacizumab to chemotherapy led to a reduction in the rate of progressive disease (16.4 vs. 30.5%, p= 0.081) and to a prolonged PFS (p= 0.028).

Conclusion: A high LDH value was confirmed as a marker of poor prognosis. Bevacizumab reduced the progressive disease rate and improved PFS in the high-LDH subgroup, making serum LDH a potentially effective an easily available and marker to select patients who benefit from bevacizumab.

Trial registration: NCT01878422 ClinicalTrials.gov.

No MeSH data available.


Related in: MedlinePlus