Chromogranin A: From Laboratory to Clinical Aspects of Patients with Neuroendocrine Tumors.
Chromogranin A: From Laboratory to Clinical Aspects of Patients with Neuroendocrine Tumors.
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DOI：
10.1155/2018/8126087
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发表时间：
2018
影响因子：
2.8
通讯作者：
Baldelli R
中科院分区：
文献类型：
--
作者：
Di Giacinto P;Rota F;Rizza L;Campana D;Isidori A;Lania A;Lenzi A;Zuppi P;Baldelli R
背景。神经内分泌肿瘤 (NET) 的特点是其行为和预后取决于肿瘤组织学、原发部位、分期和增殖指数。与类癌综合征和血管活性肠肽肿瘤相关的症状用醋酸奥曲肽治疗。 PROMID 试验评估了奥曲肽 LAR 对分化良好的转移性中肠 NET 患者肿瘤生长的影响。 CLARINET 试验评估兰瑞肽对无功能、高分化或中分化转移性肠胰 NET 患者的疗效。基于治疗组获得的积极 PFS 效果，依维莫司已被批准用于治疗晚期胰腺 NET (pNET)。舒尼替尼被批准用于治疗进展性胃肠道间质瘤或伊马替尼不耐受的患者，因为一项随机研究表明，它可以改善晚期高分化 pNET 患者的 PFS 和总生存期。在一项 II 期试验中，帕瑞肽在治疗晚期 NET 患者中显示出疗效和耐受性，这些患者的类癌综合征症状对奥曲肽 LAR 具有耐药性。一项开放标签的 II 期试验评估了长效可重复帕瑞肽在未接受治疗的 1 级或 2 级转移性 NET 患者中的临床活性。即使肿瘤的生长被显着抑制，但仍不清楚其抗增殖作用是否大于奥曲肽和兰瑞肽。由于需要新的治疗方案来对抗神经内分泌肿瘤的自然行为，因此拥有可以在这些患者的治疗中更好地解决的生化标记物也将很有用。嗜铬粒蛋白 A 是目前用于诊断的最有用的生物标志物，并且在预测疾病复发、结果和治疗效果方面具有一定的用途。
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.
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