title: Tumor marker kinetics predict outcome in patients with relapsed disseminated non-seminomatous germ-cell tumors.
abstract: BACKGROUND
  An early serum tumor marker (TM) decline during chemotherapy was shown to independently predict survival in patients with poor-prognosis disseminated non-seminomatous germ-cell tumors (NSGCTs). The aim of this study was to assess whether a TM decline (TMD) also correlates with the outcome in the salvage setting.
  
  
  METHODS
  Data regarding 400 patients with progressive or relapsed disseminated NSGCTs after first-line chemotherapy prospectively accrued onto two phase III clinical trials were obtained. Serum alpha-fetoprotein (AFP) and/or human chorionic gonadotropin (hCG) were assessed at baseline and after 6 weeks of chemotherapy. A total of 297 patients, 185 and 112 in the training and validation sets, with initially abnormal TMs for whom a change from baseline could be established were used for this analysis.
  
  
  RESULTS
  An unfavorable decline in either AFP or hCG was predictive of progression-free survival (PFS) [hazard ratio, HR = 2.15, (95% CI 1.48-3.11); P < 0.001; 2-year PFS rate: 50% versus 26%] as was the Lorch prognostic score (LPS). In the multivariate analysis, an unfavorable TMD, stratified based on the LPS, was an independent adverse prognostic factor for PFS and OS.
  
  
  CONCLUSIONS
  An unfavorable TMD during the first 6 weeks after chemotherapy is associated with a poorer outcome in patients with relapsed disseminated NSGCTs.
authors.affiliation: Department of Medical Oncology, Institut Gustave Roussy, University of Paris Sud, Villejuif. Electronic address: christophe.massard@igr.fr.
authors.forename: C
authors.initials: C
authors.lastname: Massard
authors.affiliation: Unit of Biostatistics, Centre Oscar Lambret, Lille, France.
authors.forename: A
authors.initials: A
authors.lastname: Kramar
authors.affiliation: Department of Cancer Medicine, Vivantes Klinikum am Urban, Berlin.
authors.forename: J
authors.initials: J
authors.lastname: Beyer
authors.affiliation: Cancer Center North, Christian-Albrechts-Universität zu Kiel, Keil.
authors.forename: J T
authors.initials: JT
authors.lastname: Hartmann
authors.affiliation: Genitourinary Medical Oncology, Department of Urology, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Lorch
authors.affiliation: Department of Medical Oncology, Institut Gustave Roussy, University of Paris Sud, Villejuif.
authors.forename: J L
authors.initials: JL
authors.lastname: Pico
authors.affiliation: Department of Cancer Medicine, Ospedale Ca'Foncello, Treviso, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Rosti
authors.affiliation: Department of Cancer Medicine, Centre Léon-Bérard, Lyon, France.
authors.forename: J P
authors.initials: JP
authors.lastname: Droz
authors.affiliation: Department of Medical Oncology, Institut Gustave Roussy, University of Paris Sud, Villejuif.
authors.forename: K
authors.initials: K
authors.lastname: Fizazi
mesh_terms: D000328:Adult; D014408:Biomarkers, Tumor / Q000097:blood*; D016190:Carboplatin / Q000627:therapeutic use; D006063:Chorionic Gonadotropin / Q000097:blood*; D002945:Cisplatin / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D005047:Etoposide / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007069:Ifosfamide / Q000627:therapeutic use; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy*; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy / Q000378:metabolism / Q000401:mortality; D013534:Survival; D013736:Testicular Neoplasms; D016896:Treatment Outcome; D014747:Vinblastine / Q000627:therapeutic use; D000509:alpha-Fetoproteins / Q000032:analysis*
chemical_list: D014408:Biomarkers, Tumor; D006063:Chorionic Gonadotropin; D000509:alpha-Fetoproteins; D014747:Vinblastine; D005047:Etoposide; D003520:Cyclophosphamide; D016190:Carboplatin; D002945:Cisplatin; D007069:Ifosfamide