@article{3030868,
    title = "Baseline neutrophil-to-lymphocyte ratio as a predictive and prognostic
biomarker in patients with metastatic castration-resistant prostate
cancer treated with cabazitaxel versus abiraterone or enzalutamide in
the CARD study",
    author = "de Wit, R. and Wuelfing, C. and Castellano, D. and Kramer, G. and and Eymard, J. -C. and Sternberg, C. N. and Fizazi, K. and Tombal, B. and and Bamias, A. and Carles, J. and Iacovelli, R. and Melichar, B. and and Sverrisdottir, A. and Theodore, C. and Feyerabend, S. and Helissey, C. and and Foster, M. C. and Ozatilgan, A. and Geffriaud-Ricouard, C. and de and Bono, J.",
    journal = "ESMO open",
    year = "2021",
    volume = "6",
    number = "5",
    publisher = "Elsevier",
    doi = "10.1016/j.esmoop.2021.100241",
    keywords = "metastatic castration-resistant prostate cancer; cabazitaxel;
abiraterone; enzalutamide; neutrophil-to-lymphocyte ratio; prognostic
factor",
    abstract = "Background: There is growing evidence that a high
neutrophil-to-lymphocyte ratio (NLR) is associated with poor overall
survival (OS) for patients with metastatic castration-resistant prostate
cancer (mCRPC). In the CARD study (NCT02485691), cabazitaxel
significantly improved radiographic progression-free survival (rPFS) and
OS versus abiraterone or enzalutamide in patients with mCRPC previously
treated with docetaxel and the alternative androgen-receptor-targeted
agent (ARTA). Here, we investigated NLR as a biomarker.
Patients and methods: CARD was a multicenter, open-label study that
randomized patients with mCRPC to receive cabazitaxel (25 mg/m(2) every
3 weeks) versus abiraterone (1000 mg/day) or enzalutamide (160 mg/day).
The relationships between baseline NLR {[}< versus >= median (3.38)] and
rPFS, OS, time to prostate-specific antigen progression, and
prostate-specific antigen response to cabazitaxel versus ARTA were
evaluated using Kaplan-Meier estimates. Multivariable Cox regression
with stepwise selection of covariates was used to investigate the
prognostic association between baseline NLR and OS.
Results: The rPFS benefit with cabazitaxel versus ARTA was particularly
marked in patients with high NLR \{8.5 versus 2.8 months, respectively;
hazard ratio (HR) 0.43 {[}95\% confidence interval (CI) 0.27-0.67]; P <
0.0001\}, compared with low NLR {[}7.5 versus 5.1 months, respectively;
HR 0.69 (95\% CI 0.45-1.06); P = 0.0860]. Higher NLR (continuous
covariate, per 1 unit increase) independently associated with poor OS
{[}HR 1.05 (95\% CI 1.02-1.08); P = 0.0003]. For cabazitaxel, there was
no OS difference between patients with high versus low NLR (15.3 versus
12.9 months, respectively; P = 0.7465). Patients receiving an ARTA with
high NLR, however, had a worse OS versus those with low NLR (9.5 versus
13.3 months, respectively; P = 0.0608).
Conclusions: High baseline NLR predicts poor outcomes with an ARTA in
patients with mCRPC previously treated with docetaxel and the
alternative ARTA. Conversely, the activity of cabazitaxel is retained
irrespective of NLR."
}