A continuous responder algorithm to optimize clinical management of small-cell lung cancer with progastrin-releasing peptide as a simple blood test

Abstract

This study aimed to investigate whether changes in progastrin-releasing peptide (ProGRP) levels correlate with treatment response and can be used to optimize clinical management of patients with small-cell lung cancer. Patients with small-cell lung cancer (any stage) receiving chemotherapy were eligible. ProGRP was measured in serum/plasma at baseline and after each chemotherapy cycle using the Elecsys® ProGRP assay (Roche Diagnostics). Treatment response was assessed by computed tomography scan. The primary objective was to examine whether changes in ProGRP levels correlated with computed tomography scan results after two cycles of chemotherapy. The prognostic value of ProGRP among patients receiving first-line chemotherapy was also assessed. Overall, 261 patients from six centers were eligible. Among patients with elevated baseline ProGRP (>100 pg/mL), a ProGRP decline after Cycle 2 was associated with nonprogression (area under the curve: 84%; 95% confidence interval: 72.8–95.1; n = 141). ProGRP changes from baseline to end of Cycle 1 were predictive of response, as determined by computed tomography scan 3 weeks later (area under the curve: 87%; 95% confidence interval: 74.1−99.2; n = 137). This was enhanced by repeat measurements, with a 92% area under the curve (95% confidence interval: 85.3−97.8) among patients with ProGRP data after both Cycles 1 and 2 (n = 123); if a patient experienced a ≥25% decline in ProGRP after Cycle 1, and ProGRP remained stable or decreased after Cycle 2, the probability of finding progression on the interim computed tomography scan at the end of Cycle 2 was almost zero (sensitivity: 100%, specificity: 71%). Both ProGRP levels at baseline and at the end of first-line chemotherapy were prognostic; the latter provided a moderately improved hazard ratio of 2.43 (95% confidence interval: 1.33–4.46; n = 110) versus 1.87 (95% confidence interval: 1.04–3.37; n = 216). In summary, for patients with small-cell lung cancer and elevated baseline ProGRP levels, ProGRP may be a simple, reliable, and repeatable tool for monitoring response to chemotherapy and provide valuable prognostic information.

New insights into the diagnostic characteristics and clinical application of serum biomarkers for lung cancer, and human epididymis protein 4 as a new biomarker?

“…Ming LI 1,# , Yi ZHANG 2,# , Li JIANG 3 , Yan LI 4 , Gang LI 5 , Jianping ZHOU 6 , Chen YANG 7 , Xinhui LI 8 , Wei QU 9 , Yong CHEN 10 , Qing CHEN 10 , Shukui WANG 11, *, Jinliang XING 12, *, Huayi HUANG 10,13…”

“…Numerous reports have indicated that some serum biomarkers had a fair diagnostic or prognostic performance for lung cancer. In addition, the elevation of these biomarkers could serve as a sign of distant metastasis [6,7]. Nevertheless, reports concerning the diagnostic performance of serum biomarkers on lung cancer were still inconsistent and debatable, thus the biomarkers are underutilized in clinical practice in general.…”

Metastatic small cell lung cancer – an aggressive disease: a case report and literature review

“…The 7.7 levels of NSE were at a time when the disease was stable. In a recent study by Muley et al .., Pro-GRP levels were found to be reliable and repeatable method in monitoring the disease in response to chemotherapy [16].…”

“…NSE increases in some cases of SCLC, however, the specificity and sensitivity are NS enough to consider as a diagnostic tool [15]. Progastrin releasing peptide (PRO-GRP) is a circulating marker that may have beneficial use in diagnosing SCLC [16]. It has been shown that PRO-GRP has a higher sensitivity and specificity than NSE [15,17].…”

Histological specificity and diagnostic performance of a six-biomarker panel of lung cancer: An evaluation of a geographically-based multicenter study in China

“…Numerous reports indicated that some biomarkers had a fair diagnostic or prognostic performance for lung cancer. In addition, elevation of these biomarkers could serve as sign of distant metastasis [6,7]. Nevertheless, reports concerning the diagnostic performance of biomarkers on lung cancer were still inconsistent and even contradictory, thus the markers are underutilized in clinical practice in general.…”