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The inflammation-based index can predict response and improve patient selection in NETs treated with PRRT: a pilot study

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Title: The inflammation-based index can predict response and improve patient selection in NETs treated with PRRT: a pilot study
Authors: Black, J
Atkinson, S
Singh, A
Evans, J
Sharma, R
Item Type: Journal Article
Abstract: Background Peptide Receptor Radionuclide Therapy (PRRT) is an effective treatment for certain patients with metastatic neuroendocrine tumours (NETs). Tumour response is highly variable; no biomarker in clinical practice has been demonstrated to reliably predict outcome. The Inflammation-Based Index (IBI), derived from serum C-reactive protein and albumin levels, predicts survival and response to treatment in patients in a number of cancer types and was therefore explored in this setting. Materials and Methods Clinico-pathological data from patients undergoing PRRT for metastatic NETs were collected at baseline and during treatment. The primary endpoint was progression free survival (PFS) with a secondary endpoint of overall survival (OS). Cox regression analysis tested associations between baseline variables and their dynamic changes, and PFS and OS. Decision curve analysis (DCA) was used to determine the net benefit associated with a treatment strategy determined by the baseline IBI and non-response to PRRT. Results Fifty-five patients were recruited. Baseline IBI >0 was associated with inferior PFS (HR 14.2 (95% CI 5.25-38.5), p<0.001) and OS (p<0.001). Multivariate analysis confirmed an independent association between IBI and PFS (p=0.001). DCA indicated a net clinical benefit at risk thresholds between 0.03 and 0.58. Conclusion Baseline IBI score and its dynamic change through treatment are associated with both PFS and OS. At a risk threshold equivalent to the currently accepted rate of non-response to therapy, implementation of this easily derived score could avoid a significant number of futile treatments. These findings should be validated in additional independent cohorts.
Issue Date: 1-Feb-2019
Date of Acceptance: 10-Sep-2018
URI: http://hdl.handle.net/10044/1/64646
DOI: https://dx.doi.org/10.1210/jc.2018-01214
ISSN: 0021-972X
Publisher: Oxford University Press (OUP)
Start Page: 285
End Page: 292
Journal / Book Title: Journal of Clinical Endocrinology and Metabolism
Volume: 104
Issue: 1
Copyright Statement: © 2018 Endocrine Society. This is a pre-copy-editing, author-produced version of an article accepted for publication in [insert journal title] following peer review. The definitive publisher-authenticated version is available online at: https://academic.oup.com/jcem/advance-article/doi/10.1210/jc.2018-01214/5095446
Sponsor/Funder: Imperial College Healthcare NHS Trust- BRC Funding
Funder's Grant Number: RDB01 79560
Keywords: 1103 Clinical Sciences
1114 Paediatrics And Reproductive Medicine
Endocrinology & Metabolism
Publication Status: Published
Embargo Date: 2019-09-13
Online Publication Date: 2018-09-13
Appears in Collections:Division of Surgery
Division of Cancer
Faculty of Medicine



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