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Electronic Letters to:

urogenital tumors:
Y. Loriot, C. Massard, M. Gross-Goupil, M. Di Palma, B. Escudier, A. Bossi, and K. Fizazi
Combining carboplatin and etoposide in docetaxel-pretreated patients with castration-resistant prostate cancer: a prospective study evaluating also neuroendocrine features
Ann Oncol 2009; 20: 703-708 [Abstract] [Full text] [PDF]
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[Read eLetter] CgA levels in Neuroendocrine differentiation - the right tool to assess response?
Ganessan Kichenadasse   (11 May 2009)

CgA levels in Neuroendocrine differentiation - the right tool to assess response? 11 May 2009
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Ganessan Kichenadasse,
Medical Oncologist
Flinders Medical Centre, Flinders University, Bedford Park, South Australia - 5042

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Re: CgA levels in Neuroendocrine differentiation - the right tool to assess response?

I read with interest the published study by Loriot Y et al. I was intrigued by the lack of progression free survival (PFS) benefit (median of just 2.1 months), while the median overall survival (OS) was 19 months with the combination of carboplatin and etoposide in such a poor prognostic category of docetaxel refractory advanced prostate cancer patients. There are valid reasons to believe that the assessment tools like a fall in prostate specific antigen (PSA) and imaging are inappropriate to measure response in this patient popluation with neuroendocrine differentiation (NED) akin to carcinoid tumors of the gut. Chromogranin A (CgA) levels may be a better option. It has been previously observed that CgA is a sensitive marker for NED in prostate cancer with a better prognostic value than PSA (1,2). Moreover, there is a move to use CgA levels for monitoring disease activity in gastrointestinal neuroendocrine tumors (3). I wonder if there was an assessment using CgA levels performed during and after chemotherapy by the authors of the current study, as this may be a better way to detect any response to chemotherapy and possibly explain the disparity between a short PFS and prolonged OS. There may have been a CgA response not identified by the standard assessment tools.

References

1. Berruti A, Mosca A, Tucci M, et al. Independent prognostic role of circulating chromogranine A in prostate cancer patients with hormone- refractory disease. Endocr Relat Cancer (2005) 12:109–117.

2. AlessandroS, Vincenzo G, Maria A, et al. Chromogranin A and biochemical progression-free survival in prostate adenocarcinomas submitted to radical prostatectomy. Endocr Relat Cancer (2007) 14: 625-632.

3. Korse CM, Bonfrer JM, Aaronson NK, et al. Chromogranin A as an alternative to 5-hydroxyindoleacetic acid in the evaluation of symptoms during treatment of patients with neuroendocrine Tumors. Neuroendocrinology (2009)89:296-301.

Conflict of Interest:

None declared