Chromogranin A: From Laboratory to Clinical Aspects of Patients with Neuroendocrine Tumors

Author:

Di Giacinto Paola1,Rota Francesca1,Rizza Laura1,Campana Davide2ORCID,Isidori Andrea3,Lania Andrea4,Lenzi Andrea3,Zuppi Paolo1,Baldelli Roberto1ORCID

Affiliation:

1. Endocrinological Oncology, Service of Endocrinology, A.O. San Camillo-Forlanini, Rome, Italy

2. Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, Bologna, Italy

3. Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy

4. Department of Endocrinology, Humanitas Clinical and Research Center, Humanitas University, Milan, Italy

Abstract

Background. Neuroendocrine tumors (NETs) are characterized by having behavior and prognosis that depend upon tumor histology, primary site, staging, and proliferative index. The symptoms associated with carcinoid syndrome and vasoactive intestinal peptide tumors are treated with octreotide acetate. The PROMID trial assesses the effect of octreotide LAR on the tumor growth in patients with well-differentiated metastatic midgut NETs. The CLARINET trial evaluates the effects of lanreotide in patients with nonfunctional, well-, or moderately differentiated metastatic enteropancreatic NETs. Everolimus has been approved for the treatment of advanced pancreatic NETs (pNETs) based on positive PFS effects, obtained in the treated group. Sunitinib is approved for the treatment of patients with progressive gastrointestinal stromal tumor or intolerance to imatinib, because a randomized study demonstrated that it improves PFS and overall survival in patients with advanced well-differentiated pNETs. In a phase II trial, pasireotide shows efficacy and tolerability in the treatment of patients with advanced NETs, whose symptoms of carcinoid syndrome were resistant to octreotide LAR. An open-label, phase II trial assesses the clinical activity of long-acting repeatable pasireotide in treatment-naive patients with metastatic grade 1 or 2 NETs. Even if the growth of the neoplasm was significantly inhibited, it is still unclear whether its antiproliferative action is greater than that of octreotide and lanreotide. Because new therapeutic options are needed to counter the natural behavior of neuroendocrine tumors, it would also be useful to have a biochemical marker that can be addressed better in the management of these patients. Chromogranin A is currently the most useful biomarker to establish diagnosis and has some utility in predicting disease recurrence, outcome, and efficacy of therapy.

Publisher

Hindawi Limited

Subject

Endocrine and Autonomic Systems,Endocrinology,Endocrinology, Diabetes and Metabolism

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