We found that the HALP score at the beginning of treatment in recurrent GBM patients treated with bevacizumab plus irinotecan is an independent prognostic factor for PFS and OS. PFS and OS were significantly shorter for patients in the low HALP score group than those in the high HALP score group.
Inflammatory factors have been recognized as an important contributing factor to the complexity and lethality of GBM. Therefore, many studies are carried out considering that inflammatory factors may be prognostic factors for cancers, and the search continues. Previous studies have reported that tumor necrosis factor alpha (TNF-α) and C-reactive protein (CRP) are noticeably higher in patients with glioblastoma compared to healthy controls. However, the relationship between inflammatory factors and glioma risk or prognosis is controversial. There are positive and negative studies on this . A recent study showed that elevations in all inflammatory markers were associated with poor OS in those using bevacizumab in recurrent GBM, but only elevated CRP to albumin ratio (CAR) and platelet to lymphocyte ratio (PLR) were reported to be an independent predictive factor. The prognostic significance of the increase in neutrophil to lymphocyte ratio (NLR) has not been demonstrated in this study .
As known, while hemoglobin and albumin levels are associated with the nutrition status of the body, lymphocytes and platelets are related to the immune system. The HALP score has been usually used to predict the prognosis of some types of cancers by using the character of showing the two main roles (inflammation and nutrition status) in the prognosis of cancer . Chen et al. firstly described this HALP score to predict the prognosis of gastric cancer. In 1332 patients with gastric cancer who underwent gastrectomy, the preoperative HALP ≥ 56.8 group had a significantly better prognosis than the HALP < 56.8 group . Also, the prognostic effectiveness of the HALP score has been investigated in
, esophageal squamous cell cancer , pancreatic cancer , colorectal cancer , renal cell carcinoma , bladder cancer , prostate cancer [15, 16], and small cell lung cancer [17, 18]. Low HALP score was associated with worse survival outcomes in all studied cancers. However, the optimum cut-off value was different in each study, so it is very important to define the optimal cut-off value of HALP score.
Bevacizumab, a humanized monoclonal IgG1 antibody, acts to bind to human VEGF and inhibit its activity . The objective response rate (ORR) achieved with the combination of bevacizumab plus irinotecan in recurrent GBM is 38%, and the median PFS and OS are 5.6 and 9.2 months, respectively . Predictive factors of bevacizumab response in recurrent GBM have been investigated in several studies. In these studies, it has been shown that the development of hypertension and proteinuria, high eosinophil and lymphocyte levels, and low CAR and PLR values due to bevacizumab treatment are predictive for better survival [6, 7, 19].
In conclusion, this is the first study to show that the HALP score predicts the response to bevacizumab plus irinotecan treatment in patients with recurrent GBM. This score will be useful because it can be easily calculated with routine blood tests, is cheap and objective. We think that it can be used in routine practice if the same result is obtained as a result of studies with a larger number of patients.