Background
The IL-6/STAT3 axis promotes inflammation, angiogenesis, and cancer. The effect of genetic variants within this pathway on benefit from anti-angiogenic cancer therapy is unknown. We tested whether single nucleotide polymorphisms (SNPs) in genes involved in IL-6/STAT3 signaling can predict efficacy of bevacizumab-based chemotherapy in metastatic colorectal cancer (mCRC) patients
Methods
Associations between potentially functional IL-6 (rs2069837, rs1800795) and STAT3 (rs744166, rs4796793) SNPs and clinical outcomes (progression-free survival, overall survival and tumor response rate) were evaluated in mCRC patients receiving first-line FOLFIRI plus bevacizumab in two randomized phase III trials: TRIBE (n=223, training cohort) and FIRE-3 (n=288, validation cohort). Patients receiving FOLFIRI plus cetuximab in FIRE-3 (n=264) served as a control cohort. The interaction between genotype and primary tumor location with clinical outcomes was examined. Genomic DNA isolated from whole blood or tumor tissue was analyzed by PCR-based direct sequencing.
Results
Patients with an IL-6 rs2069837 G allele treated with FOLFIRI plus bevacizumab had an inferior PFS than those with the A/A genotype in TRIBE (9.4 v. 11.1 months, HR=1.53, 95% CI 1.12, 2.10, P=0.004) and FIRE-3 (8.8 v. 10.9 months, HR=1.40, 95% CI 1.06, 1.85, P=0.015). These associations were confirmed in multivariable analyses, and were not seen in the control cohort. In subgroup analysis, the effect of IL-6 rs2069837 on PFS was present only in patients with left-sided cancers, but the test for interaction was not significant.
Conclusion
IL-6 rs2069837 genotype is a clinically relevant prognostic factor in mCRC patients treated with first-line bevacizumab-based chemotherapy.