Response to Therapy

The ability to monitor response to therapy is among GCT markers' most important roles. In a disease in which rapid growth and progression to a worse prognostic group or even to incurability are potential threats, early indication of ineffectual treatment may allow a more aggressive therapy to be instituted in a more timely fashion. After complete surgical excision of all viable tumor, one would expect that each marker would decline according to its half-life (ti/2), which is known to be 4.5 days for AFP, 16 to 24 hours for hCG, and 1 day for LDH. Chemotherapy, on the other hand, does not immediately eliminate all disease; therefore, the rate of decline is more complex. Although many criteria have been published, there is no consensus on which of these criteria should be used. Empirically, a 10-fold decrease in serum marker levels seen over a 3-week period has been consistent with a good disease response.58 The group at Memorial Sloan-Kettering Cancer Center proposed that a satisfactory t1/2 after chemotherapy was < 3 days for hCG and < 7 days for AFP. They found that patients with a satisfactory marker decrease as defined by this criterion had complete remission rates of 89%, compared to only 9% for patients with a slower regression.64 Another strategy used the ratio between marker levels at the initiation of chemotherapy and levels on day 22 of the first cycle. A 200-fold

Table 7-2.

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