Originally published as JCO Early Release 10.1200/JCO.2004.04.008 on August 9 2004

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Fizazi, K. Articles by Logothetis, C. J. Search for Related Content PubMed PubMed Citation Articles by Fizazi, K. Articles by Logothetis, C. J. Related Articles Related Editorial Social Bookmarking                            What's this?

Early Predicted Time to Normalization of Tumor Markers Predicts Outcome in Poor-Prognosis Nonseminomatous Germ Cell Tumors

From the Genito-Urinary Group of the French Federation of Cancer Centers, Paris, France; and the Department of Genitourinary Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.

Address reprint requests to Karim Fizazi, MD, PhD, Department of Medicine, Institut Gustave Roussy, 39 rue Camille Desmoulins, 94800 Villejuif, France; e-mail: fizazi{at}igr.fr

PURPOSE: The prognostic relevance of the rate of decline of serum alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG) during the first 3 weeks of chemotherapy for nonseminomatous germ cell tumors (NSGCT) was studied in the context of the International Germ Cell Cancer Collaborative Group (IGCCCG) classification.

PATIENTS AND METHODS: Data from 653 patients prospectively recruited in clinical trials were studied. Tumor markers were obtained before chemotherapy and 3 weeks later. Decline rates were calculated using a logarithmic formula and expressed as a predicted time to normalization (TTN). A favorable TTN was defined when both AFP and HCG had a favorable decline rate, including cases with normal values.

RESULTS: The median follow-up was 50 months (range, 2 to 151 months). Tumor decline rate expressed as a predicted TTN was associated with both progression-free survival (PFS; P < .0001) and overall survival (OS; P < .0001). The 4-year PFS rates were 64% and 38% in patients from the poor-prognosis group who had a favorable and an unfavorable TTN, respectively. The 4-year OS rates were 83% and 58%, respectively. This effect was independent from the initial tumor marker values, the primary tumor site, and the presence of nonpulmonary visceral metastases: tumor marker decline rate remained a strong predictor for both PFS (hazard ratio = 2.5; P = .01) and OS (hazard ratio = 4.6; P = .002) in patients from the IGCCCG poor-prognosis group in multivariate analysis.

CONCLUSION: Early predicted time to tumor marker normalization is an independent prognostic factor in patients with poor-prognosis NSGCT and may be a useful tool in the therapeutic management of these patients.

Presented in part at the 38th Annual Meeting of the American Society of Clinical Oncology, Orlando, FL, May 18-21, 2002.

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

Related Editorial

• Early Identification of Therapeutic Failure in Nonseminomatous Germ Cell Tumors by Assessing Serum Tumor Marker Decline During Chemotherapy: Still Not Ready for Routine Clinical Use
  Guy C. Toner
  JCO 2004 22: 3842-3845 [Full Text]

This article has been cited by other articles:

				B. Besse, D. Grunenwald, A. Flechon, A. Caty, C. Chevreau, S. Culine, C. Theodore, and K. Fizazi Nonseminomatous germ cell tumors: assessing the need for postchemotherapy contralateral pulmonary resection in patients with ipsilateral complete necrosis. J. Thorac. Cardiovasc. Surg., February 1, 2009; 137(2): 448 - 452. [Abstract] [Full Text] [PDF]

				R. Thuret, C. Massard, M. Gross-Goupil, B. Escudier, M. Di Palma, A. Bossi, R. de Crevoisier, A. Chauchereau, and K. Fizazi The postchemotherapy PSA surge syndrome Ann. Onc., July 1, 2008; 19(7): 1308 - 1311. [Abstract] [Full Text] [PDF]

				K. Fizazi, J. Oldenburg, A. Dunant, I. Chen, R. Salvioni, J. T. Hartmann, M. De Santis, G. Daugaard, A. Flechon, U. de Giorgi, et al. Assessing prognosis and optimizing treatment in patients with postchemotherapy viable nonseminomatous germ-cell tumors (NSGCT): results of the sCR2 international study Ann. Onc., February 1, 2008; 19(2): 259 - 264. [Abstract] [Full Text] [PDF]

				S. Culine, A. Kramar, C. Theodore, L. Geoffrois, C. Chevreau, P. Biron, B. B. Nguyen, J.-F. Heron, P. Kerbrat, A. Caty, et al. Randomized Trial Comparing Bleomycin/Etoposide/Cisplatin With Alternating Cisplatin/Cyclophosphamide/Doxorubicin and Vinblastine/Bleomycin Regimens of Chemotherapy for Patients With Intermediate- and Poor-Risk Metastatic Nonseminomatous Germ Cell Tumors: Genito-Urinary Group of the French Federation of Cancer Centers Trial T93MP J. Clin. Oncol., January 20, 2008; 26(3): 421 - 427. [Abstract] [Full Text] [PDF]

				D. J. Vaughn and E. A. Stadtmauer Poor-Prognosis Germ Cell Tumors: We Have Not Yet Crossed the Finish Line J. Clin. Oncol., January 20, 2007; 25(3): 239 - 240. [Full Text] [PDF]

				R. J. Motzer, C. J. Nichols, K. A. Margolin, J. Bacik, P. G. Richardson, N. J. Vogelzang, D. F. Bajorin, P. N. Lara Jr, L. Einhorn, M. Mazumdar, et al. Phase III Randomized Trial of Conventional-Dose Chemotherapy With or Without High-Dose Chemotherapy and Autologous Hematopoietic Stem-Cell Rescue As First-Line Treatment for Patients With Poor-Prognosis Metastatic Germ Cell Tumors J. Clin. Oncol., January 20, 2007; 25(3): 247 - 256. [Abstract] [Full Text] [PDF]

				G. C. Toner Early Identification of Therapeutic Failure in Nonseminomatous Germ Cell Tumors by Assessing Serum Tumor Marker Decline During Chemotherapy: Still Not Ready for Routine Clinical Use J. Clin. Oncol., October 1, 2004; 22(19): 3842 - 3845. [Full Text] [PDF]