Predicting outcome to chemotherapy in patients with germ cell tumors: The value of the rate of decline of human chorionic gonadotrophin and alpha-fetoprotein during therapy

Purpose: The prognostic significance of the rate of decline of the serum tu mor marker alpha-fetoprotein (AFP) and human chorionic gonadotrophin (HCG) during the first two cycles of chemotherapy in germ cell tumor (GCT) patien ts was initially reported by us, but its value hers been debated. We re-exa mined this issue in the context of the international Germ Cell Cancer Colla borative Group (IGCCCG) risk classification system and investigated the rol e of including in the analysis patients whose markers normalized early. Patients and Methods: One hundred eighty-nine GCT patients with elevated AF P/HCG marker valves treated with platinum-based chemotherapy between 1986 a nd 1998 were included in this analysis. patients were classified as good, i ntermediate, or poor risk by the IGCCCG criteria and as having satisfactory or unsatisfactory marker decline. Risk and marker decline were correlated with response, event-free survival, and overall survival. Results: Satisfactory marker decline predicted improved complete response ( CR) proportion and event-free and overall survival (P <.0001). The CR propo rtion, 2-year event-free, and a-year overall survival rates for patients wi th a satisfactory and unsatisfactory marker decline were 92% versus 62%, 91 % versus 69%, and 95% versus 72%, respectively. Marker decline remained a s ignificant variable for all three end points when adjusted for risk (P <.01 ) with the outcome differences most pronounced in the poor-risk group. Conclusion: The rate of marker decline during chemotherapy has prognostic v alue independent of risk and may play a significant role in the management of poor-risk patients. It is appropriate to include patients whose markers normalized early. J Clin Oncol 19:2534 2541. (C) 2001 by American Society o f Clinical Oncology.