Among patients with early or advanced melanoma, elevated blood levels of C-reactive protein (CRP) predicted disease recurrence and poorer survival. In a subset of patients who had sequential blood draws, CRP levels indicated melanoma disease progression, according to a study published online March 16 in the Journal of Clinical Oncology.
CRP measurements for 1,144 patients demonstrated that elevated CRP was associated with increased overall risk of death (hazard ratio, 1.44/U increase of logarithmic CRP; 95% confidence interval, 1.30-1.59; P < .001), reported Dr. Shenying Fang of the University of Texas MD Anderson Cancer Center, Houston, and his associates.
“These data provide strong evidence that CRP is an independent prognostic biomarker in patients with melanoma, including those with early-stage disease as well as those with advanced-stage disease. A markedly elevated CRP level in particular seems to identify a subgroup of patients at high risk for disease recurrence and death,” they said (J. Clin. Onc. 2015 March 16 [doi: 10.1200/JCO.2014.58.0209]).
Investigators demonstrated a dose effect by dividing CRP levels into quintiles and showing patients in the highest quintile had significantly poorer overall survival than did those in the lowest quintile (HR, 4.14; 2.58-6.64), and significant trends across quintiles. Recursive partitioning indicated the best CRP cutoff value was 10.94 mg/L, close to the commonly used clinical cutoff of 10 mg/L. CRP levels greater than or equal to 10 mg/L predicted poorer survival and higher rates of recurrence.
For a subset of 115 patients, data from sequential blood draws showed a correlation between increasing CRP levels in an individual and disease progression. Changes in CRP levels were obtained at a median of 17.12 months apart, and increased levels were associated with poorer response to treatment (P < .001), progression of disease (P < .001), increase in cancer stage (P = .0065), and increase vs. no increase in number of metastases (P = .0013).
Dr. Fang and his associates suggest further studies on potential benefits of reducing inflammation and/or CRP on melanoma patients. Statins reduce CRP levels, but their effect on cancer prevention is unclear.
“Although there is as yet no defined role for clinical use of statins in cancer treatment, our data suggest that preclinical evaluation of statin therapy in melanoma models is reasonable to pursue,” they wrote.