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Health-related quality of life in patients with metastatic colorectal cancer, association with systemic inflammatory response and RAS and BRAF mutation status

European Journal of Cancer, August 2017, Volume 81, Pages 26-35



The aim of this study was to evaluate the effect of cetuximab on health-related quality of life (HRQoL) in the NORDIC-VII trial on metastatic colorectal cancer (mCRC), and to assess HRQoL in relation to RAS and BRAF mutation status and inflammatory biomarkers.

Patient and methods

HRQoL was assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (QLQ-C30) at baseline, after every fourth cycle of chemotherapy, and at the end of treatment. HRQoL during 12 cycles of chemotherapy was evaluated over time, compared between treatment arms, and assessed for association with tumour mutation status and inflammatory markers.


QLQ-C30 was completed by 512 patients (90%) before start of treatment. HRQoL variables were well balanced across treatment arms at baseline, and no statistically significant differences during treatment were seen. Patients with BRAF -mutated tumours reported poorer HRQoL at baseline and subsequent time points than patients with RAS -mutated or RAS / BRAF wild-type tumours. Patients with high serum interleukin-6 (IL-6) or C-reactive protein (CRP) had markedly impaired HRQoL compared to patients with normal levels. There was a statistically significant association between reduction in IL-6 and CRP levels and improvement in HRQoL during treatment from baseline to cycle 4.


The addition of cetuximab to chemotherapy did not affect HRQoL in mCRC patients. Patients with BRAF -mutated tumours have both a worse prognosis and a poor HRQoL. The associations between levels of systemic inflammatory markers and reduced HRQoL suggest that the patients might benefit from anti-inflammatory treatment.



  • Adding cetuximab to oxaliplatin-based chemotherapy did not influence health-related quality of life (HRQoL).

  • Patients with BRAF -mutated tumour had worse HRQoL scores than those with RAS / BRAF wild-type or RAS -mutated tumours.

  • Patients with high inflammatory biomarkers, indicating systemic inflammation, had markedly worse HRQoL.

  • C-reactive protein as biomarker of systemic inflammation, can be useful in the management of metastatic colorectal cancer.


Keywords: HRQoL, mCRC, Chemotherapy, RAS and BRAF mutation status, Inflammation.