Determinants of cancer progression and survival are multifactorial and host responses are increasingly appreciated to play a major role.  Indeed, the development and maintenance of a systemic inflammatory response has been consistently observed to confer poorer outcome, in both early and advanced stage disease.  In the last decade or so a number of prognostic scores have been developed to simply and objectively measure this systemic inflammatory response.  Of these the Glasgow Prognostic Score (GPS) and the Neutrophil Lymphocyte Ratio (NLR) have been most frequently validated in patients with a variety of common solid tumours (1, 2) and this has led to calls for the routine assessment of the score in all patients with cancer and in particular in the recruitment to randomised controlled trials (3).

More recently, given the their proven prognostic reliability, the value of the systemic inflammatory response and the GPS and NLR assessments for monitoring and as therapeutic targets has attracted considerable interest in patients with advanced cancer (4, 5).   For these patients, cancer associated symptoms are of particular importance resulting in a marked impact on day-to-day quality of life and are also associated with poorer outcome.  These symptoms are now recognised to cluster with one another with anorexia, weight loss and physical function forming a recognised cluster and fatigue, pain and depression another.  Importantly, it has become apparent that these symptom clusters are associated with presence of a systemic inflammatory response in the patient with advanced cancer (5).

In order that the systemic inflammatory response be targeted in a rationale manner in these patients the links between the tumour and the systemic inflammatory response are of considerable interest.  This will be the principal topic of the plenary talk.