1 The Faculty of Medicine, Aalborg University, VBN2 Aalborg University Hospital, The Faculty of Medicine, Aalborg University, VBN3 Klinik Kirurgi og Kræftbehandling, The Faculty of Medicine, Aalborg University, VBN4 Kræftbehandling (Onkologi), The Faculty of Medicine, Aalborg University, VBN5 Onkologi6 Department of Oncology, Oslo University Hospital, Oslo, Norway.7 Departments of Radiology, Oncology and Radiation Science, Uppsala University, Uppsala, Sweden and Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden.8 The Finsen Laboratory, Copenhagen University Hospital, Copenhagen, Denmark and Biotech Research and Innovation Center (BRIC), University of Copenhagen, Copenhagen, Denmark.9 Department of Oncology, Odense University Hospital, Odense, Denmark.10 Department of Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway.11 Department of Oncology, Haukeland University Hospital, Bergen, Norway.12 Departments of Oncology and Medicine, Herlev Hospital, Copenhagen University Hospital, Copenhagen, Denmark.
RESULTS from the NORDIC VII Study
BACKGROUND: We aim to test the hypothesis that high plasma YKL-40 is associated with short progression-free survival (PFS) and overall survival (OS) in patients with metastatic colorectal cancer (mCRC) treated with first-line oxaliplatin and 5-flourouracil with or without cetuximab. PATIENTS AND METHODS: A total of 566 patients in the NORDIC VII Study were randomized 1∶1∶1 to arm A (Nordic FLOX), arm B (Nordic FLOX + cetuximab), or arm C (Nordic FLOX + cetuximab for 16 weeks followed by cetuximab alone as maintenance therapy). Pretreatment plasma samples were available from 510 patients. Plasma YKL-40 was determined by ELISA and dichotomized according to the age-corrected 95% YKL-40 level in 3130 healthy subjects. RESULTS: Pretreatment plasma YKL-40 was elevated in 204 patients (40%), and median YKL-40 was higher in patients with mCRC than in healthy subjects (age adjusted, P<0.001). Patients with elevated YKL-40 had shorter PFS than patients with normal YKL-40 (7.5 vs. 8.2 months; hazard ratio (HR) = 1.27 95% confidence interval (CI) 1.05-1.53 P = 0.013) and shorter OS (16.8 vs. 23.9 months; HR = 1.33, 1.04-1.69, P = 0.024). Multivariate Cox analysis demonstrated that elevated pretreatment YKL-40 was an independent biomarker of short OS (HR = 1.12, 1.01-1.25, P = 0.033). The ratio of the updated plasma YKL-40 (i.e. level after 1, 2, 8 weeks of treatment, and at end of treatment compared to the baseline level) was associated with OS (HR = 1.27, 1.06-1.52, P = 0.011). CONCLUSIONS: Plasma YKL-40 is an independent prognostic biomarker in patients with mCRC treated with first-line oxaliplatin-based therapy alone or combined with cetuximab.