Management strategies and outcomes of germ cell tumor patients with very high human chorionic gonadotropin levels

Robin T. Zon, Craig Nichols, Lawrence Einhorn

Research output: Contribution to journalArticle

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Abstract

Purpose: To determine the therapeutic results in advanced germ cell tumor (GCT) patients with initial human chorionic gonadotropin (hCG) elevation greater than 50,000 mIU/mL and to document the levels of hCG decline and subsequent plateau and outcome of this patient population. Patients and Methods: We conducted a retrospective review of 41 patients who presented to Indiana University (IU) with hCG levels greater than 50,000 mIU/mL between December 1976 and August 1996. All patients had received cisplatin-containing regimens and were monitored with serial hCG levels. Results: Twenty-two of 41 (53.7%) patients continuously show no evidence of disease (NED) and eight additional patients (19.5%) are currently NED with salvage therapy. Only two of 41 patients had a normal hCG level at the start of the fourth and final course of cisplatin combination chemotherapy. Eight additional patients showed normalized hCG levels 1 month later. Seven of these 10 are continuously NED and three are currently NED with salvage therapy. Thirty-one patients had an abnormal hCG greater than 1 month after they completed primary chemotherapy; 15 of these patients (48%) are continuously NED despite no further therapy and five additional patients (16) are currently NED with salvage therapy. Overall, them was an initial rapid decline in hCG followed by a plateau after the first two courses of therapy. Conclusion: Less than 10% of patients who present with hCG levels greater than 50,000 mIU/mL will have a normal hCG at the institution of the fourth and final course of chemotherapy. However, 22 of 41 (53.7%) are continuously NED despite no further therapy. We feel that the optimal strategy for such patients is monthly observation with initiation of salvage therapy if and when there is serologic progression.

Original languageEnglish
Pages (from-to)1294-1297
Number of pages4
JournalJournal of Clinical Oncology
Volume16
Issue number4
StatePublished - Apr 1998

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Germ Cell and Embryonal Neoplasms
Chorionic Gonadotropin
Salvage Therapy
Cisplatin
Drug Therapy
Therapeutics
Combination Drug Therapy

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Management strategies and outcomes of germ cell tumor patients with very high human chorionic gonadotropin levels. / Zon, Robin T.; Nichols, Craig; Einhorn, Lawrence.

In: Journal of Clinical Oncology, Vol. 16, No. 4, 04.1998, p. 1294-1297.

Research output: Contribution to journalArticle

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abstract = "Purpose: To determine the therapeutic results in advanced germ cell tumor (GCT) patients with initial human chorionic gonadotropin (hCG) elevation greater than 50,000 mIU/mL and to document the levels of hCG decline and subsequent plateau and outcome of this patient population. Patients and Methods: We conducted a retrospective review of 41 patients who presented to Indiana University (IU) with hCG levels greater than 50,000 mIU/mL between December 1976 and August 1996. All patients had received cisplatin-containing regimens and were monitored with serial hCG levels. Results: Twenty-two of 41 (53.7{\%}) patients continuously show no evidence of disease (NED) and eight additional patients (19.5{\%}) are currently NED with salvage therapy. Only two of 41 patients had a normal hCG level at the start of the fourth and final course of cisplatin combination chemotherapy. Eight additional patients showed normalized hCG levels 1 month later. Seven of these 10 are continuously NED and three are currently NED with salvage therapy. Thirty-one patients had an abnormal hCG greater than 1 month after they completed primary chemotherapy; 15 of these patients (48{\%}) are continuously NED despite no further therapy and five additional patients (16) are currently NED with salvage therapy. Overall, them was an initial rapid decline in hCG followed by a plateau after the first two courses of therapy. Conclusion: Less than 10{\%} of patients who present with hCG levels greater than 50,000 mIU/mL will have a normal hCG at the institution of the fourth and final course of chemotherapy. However, 22 of 41 (53.7{\%}) are continuously NED despite no further therapy. We feel that the optimal strategy for such patients is monthly observation with initiation of salvage therapy if and when there is serologic progression.",
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