Purpose: Breast cancer is one of the most common causes of cancer death in women worldwide. The Glasgow Prognostic Score (GPS), a cumulative prognostic score based on C-reactive protein and albumin, indicates the presence of a systemic inflammatory response. The GPS has been adopted as a powerful prognostic tool for patients with various types of malignant tumors, including breast cancer. The aim of this study was to assess the value of the GPS in predicting the response and toxicity in breast cancer patients treated with chemotherapy. Patients and Methods: Patients with metastatic breast cancers in a progressive stage for consideration of chemotherapy were eligible. The clinical characteristics and demographics were recorded. The GPS was calculated before the onset of chemotherapy. Data on the response to chemotherapy and progression-free survival (PFS) were also collected. Objective tumor responses were evaluated according to Response Evaluation Criteria in Solid Tumors (RECIST). Toxicities were graded according to National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTC) version 3.0 throughout therapy. Results: In total, 106 breast cancer patients were recruited. The GPS was associated with the response rate (p = 0.05), the clinical benefit rate (p = 0.03), and PFS (p = 0.005). The GPS was the only independent predictor of PFS (p = 0.005). The GPS was significantly associated with neutropenia, thrombocytopenia, anorexia, nausea and vomiting, fatigue, and mucositis (p = 0.05-0.001). Conclusions: Our data demonstrate that GPS assessment is associated with poor clinical outcomes and severe chemotherapy-related toxicities in patients with metastatic breast cancer who have undergone chemotherapy, without any specific indication regarding the type of chemotherapy applied.

Akyol M, Demir L, Alacacioglu A, Ellidokuz H, Kucukzeybek Y, Yildiz Y, Gumus Z, Bayoglu V, Yildiz I, Salman T, Varol U, Kucukzeybek B, Demir L, Dirican A, Sutcu R, Tarhan MO: The effects of adjuvant endocrine treatment on serum leptin, serum adiponectin and body composition in patients with breast cancer: the Izmir Oncology Group (IZOG) Study. Chemotherapy 2015;61:57-64.
Donohoe CL, Ryan AM, Reynolds JV: Cancer cachexia: mechanisms and clinical implications. Gastroenterol Res Pract 2011;2011:601434.
Wen HS, Li X, Cao YZ, Zhang CC, Yang F, Shi YM, Peng LM: Clinical studies on the treatment of cancer cachexia with megestrol acetate plus thalidomide. Chemotherapy 2012;58:461-467.
Partridge M, Fallon M, Bray C, McMillan D, Brown D, Laird B: Prognostication in advanced cancer: a study examining an inflammation-based score. J Pain Symptom Manage 2012;44:161-167.
El-Mowafy AM, El-Mesery ME, Salem HA, Al-Gayyar MM, Darweish MM: Prominent chemopreventive and chemoenhancing effects for resveratrol: unraveling molecular targets and the role of C-reactive protein. Chemotherapy 2010;56:60-65.
Shimoda M, Katoh M, Kita J, Sawada T, Kubota K: The Glasgow Prognostic Score is a good predictor of treatment outcome in patients with unresectable pancreatic cancer. Chemotherapy 2010;56:501-506.
Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, Verweij J, Van Glabbeke M, van Oosterom AT, Christian MC, Gwyther SG: New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 2000;92:205-216.
Laird BJ, Kaasa S, McMillan DC, Fallon MT, Hjermstad MJ, Fayers P, Klepstad P: Prognostic factors in patients with advanced cancer: a comparison of clinicopathological factors and the development of an inflammation-based prognostic system. Clin Cancer Res 2013;19:5456-5464.
Ishizuka M, Nagata H, Takagi K, Iwasaki Y, Kubota K: Inflammation based prognostic system predicts survival after surgery for stage IV colorectal cancer. Am J Surg 2013;205:22-28.
Vashist YK, Loos J, Dedow J, Tachezy M, Uzunoglu G, Kutup A, Yekebas EF, Izbicki JR: Glasgow Prognostic Score is a predictor of perioperative and long-term outcome inpatients with only surgically treated esophageal cancer. Ann Surg Oncol 2011;18:1130-1138.
Gioulbasanis I, Pallis A, Vlachostergios PJ, Xyrafas A, Giannousi Z, Perdikouri IE, Makridou M, Kakalou D, Georgoulias V: The Glasgow Prognostic Score (GPS) predicts toxicity and efficacy in platinum-based treated patients with metastatic lung cancer. Lung Cancer 2012;77:383-388.
Wang DS, Luo HY, Qiu MZ, Wang ZQ, Zhang DS, Wang FH, Li YH, Xu RH: Comparison of the prognostic values of various inflammation based factors in patients with pancreatic cancer. Med Oncol 2012;29:3092-3100.
Wang DS, Ren C, Qiu MZ, Luo HY, Wang ZQ, Zhang DS, Wang FH, Li YH, Xu RH: Comparison of the prognostic value of various preoperative inflammation-based factors in patients with stage III gastric cancer. Tumour Biol 2012;33:749-756.
Al Murri AM, Bartlett JM, Canney PA, Doughty JC, Wilson C, McMillan DC: Evaluation of an inflammation-based prognostic score (GPS) in patients with metastatic breast cancer. Br J Cancer 2006;94:227-230.
Krzystek-Korpacka M, Matusiewicz M, Diakowska D, Grabowski K, Blachut K, Kustrzeba-Wojcicka I, et al: Acute-phase response proteins are related to cachexia and accelerated angiogenesis in gastroesophageal cancers. Clin Chem Lab Med 2008;46:359-364.
Kerem M, Ferahkose Z, Yilmaz UT, Pasaoglu H, Ofluoglu E, Bedirli A, Salman B, Sahin TT, Akin M: Adipokines and ghrelin in gastric cancer cachexia. World J Gastroenterol 2008;14:3633-3641.
Mantovani G, Macciò A, Lai P, Massa E, Ghiani M, Santona MC: Cytokine activity in cancer-related anorexia/cachexia: role of megestrol acetate and medroxyprogesterone acetate. Semin Oncol 1998;25:45-52.
Argiles JM, Lopez-Soriano FJ, Busquets S: Counteracting inflammation: a promising therapy in cachexia. Crit Rev Oncog 2012;17:253-262.
Kim HJ, Kim HJ, Yun J, Kim KH, Kim SH, Lee SC, Bae SB, Kim CK, Lee NS, Lee KT, Park SK, Won JH, Park HS, Hong DS: Pathophysiological role of hormones and cytokines in cancer cachexia. J Korean Med Sci 2012;27:128-134.
Ramsey S: The role of the systemic inflammatory response as a biomarker in immunotherapy for renal cell cancer. Mol Diagn Ther 2009;13:277-281.
Crumley AB, McMillan DC, McKernan M, McDonald AC, Stuart RC: Evaluation of an inflammation-based prognostic score in patients with inoperable gastro-oesophageal cancer. Br J Cancer 2006;94:637-641.
Kim Y, Kim SJ, Hwang D, Jang J, Hyun SY, Kim YR, Kim JS, Min YH, Cheong JW: The modified Glasgow Prognostic Scores as a predictor in diffuse large B cell lymphoma treated with R-CHOP regimen. Yonsei Med J 2014;55:1568-1575.
Crumley AB, Stuart RC, McKernan M, McDonald AC, McMillan DC: Comparison of an inflammation-based prognostic score (GPS) with performance status (ECOG-ps) in patients receiving palliative chemotherapy for gastroesophageal cancer. J Gastroenterol Hepatol 2008;23:325-329.
Morinaga S, Murakawa M, Katayama Y, Yamaoku K, Aoyama T, Kanazawa A, Higuchi A, Shiozawa M, Kobayashi S, Ueno M, Morimoto M: Glasgow Prognostic Score predicts clinical outcomes in patients with pancreatic cancer undergoing adjuvant gemcitabine monotherapy after curative surgery. Anticancer Res 2015;35:4865-4870.
Pu YS, Hour TC, Chuang SE, Cheng AL, Lai MK, Kuo ML: Interleukin-6 is responsible for drug resistance and anti-apoptotic effects in prostatic cancer cells. Prostate 2004;60:120-129.
Kotler DP: Cachexia. Ann Intern Med 2000;133:622-634.
Kurebayashi J: Regulation of interleukin-6 secretion from breast cancer cells and its clinical implications. Breast Cancer 2000;7:124-129.
Arrieta O, Michel Ortega RM, Villanueva-Rodríguez G, Serna-Thomé MG, Flores-Estrada D, Diaz-Romero C, Rodríguez CM, Martínez L, Sánchez-Lara K: Association of nutritional status and serum albumin levels with development of toxicity in patients with advanced non small cell lung cancer treated with paclitaxel-cisplatin chemotherapy: a prospective study. BMC Cancer 2010;10:50-55.
Maillet M, Dréanic J, Dhooge M, Mir O, Brezault C, Goldwasser F, Chaussade S, Coriat R: The predictive and prognostic value of the Glasgow Prognostic Score in metastatic colorectal carcinoma patients receiving bevacizumab. Anticancer Drugs 2014;25:1215-1219.
McKernan M, McMillan DC, Anderson JR, Angerson WJ, Stuart RC: The relationship between quality of life (EORTC QLQ-C30) and survival in patients with gastro-oesophageal cancer. Br J Cancer 2008;98:888-893.
Tsuji D, Kamezato M, Daimon T, Taku K, Hatori M, Ikeda M, Hayashi H, Inoue K, Eto T, Itoh K: Retrospective analysis of severe neutropenia in patients receiving concomitant administration of docetaxel and clarithromycin. Chemotherapy 2013;59:407-413.
Slaviero KA, Clarke SJ, Rivory LP: Inflammatory response: an unrecognised source of variability in the pharmacokinetics and pharmacodynamics of cancer chemotherapy. Lancet Oncol 2003;4:224-232.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.