Serum tumor markers and patient allocation to good-risk and poor-risk clinical trials in patients with germ cell tumors

Article Abstract:

Chemotherapeutic treatment for cancer is more effective in some patients than in others. It would be extremely valuable to reliably predict which patients are most likely to do well and which are most likely to do poorly. This would have two benefits; it would permit dose reduction and the consequent reduction in side effects among those patients likely to do well, and it would permit the more aggressive treatment of the patients likely to do poorly, thereby, increasing their chances of cure. Unfortunately, much of what we know about distinguishing good-risk from poor-risk patients has been determined retrospectively. Nevertheless, several research groups have devised mathematical formulas that take into account a variety of prognostic variables and assign an objective prediction of the risk of relapse for a particular patient. Two such models were evaluated for the assignment of patients with germ cell (sex cell) tumors including seminomas (tumors of the testes), extragonadal nonseminomatous germ cell tumors, and testicular nonseminomatous germ cell tumors. A total of 205 patients were classified and treated as good risk or poor risk patients using a model developed at Memorial Hospital (MH). The patients and their outcomes were then compared and separated into good or poor risk groups using the Indiana University (IU) classification. With the MH model, 166 patients were classified as good risk; using the IU model, only 139 patients were so classified. However, complete responses were achieved by 95 percent with either model. Of the 33 patients classified as poor risk by the IU model, but treated as good risk in the MH model, the complete response rate was 91 percent. These results indicate that the net result of using the IU model would have been to expose good risk patients to more severe treatment. The main difference between the two models is that the MH model places more importance on the levels of serum tumor markers such as human chorionic gonadotropin and lactic dehydrogenase. This indicates that these serum tumor markers must be taken into account if patients with germ cell tumors are to be appropriately classified and treated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Usage, Prognosis, Identification and classification, Cancer treatment, Tumors, Tumor markers

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The role of ifosfamide plus cisplatin-based chemotherapy as salvage therapy for patients with refractory germ cell tumors

Article Abstract:

Complete responses can be achieved by 70 to 80 percent of patients with germ cell tumors by chemotherapy. However, 20 to 30 percent of patients will not enjoy a durable response, and salvage chemotherapy must be used to obtain further responses among patients suffering relapse. A combination chemotherapy employing etoposide and cisplatin has been shown to be effective in the treatment of patients who relapsed after receiving standard chemotherapy based on vinblastine and cisplatin. This therapy is not likely to be effective, however, in patients who only achieved a partial response to cisplatin-based chemotherapy. A study was conducted to determine if the addition of ifosfamide to cisplatin and etoposide might achieve more favorable responses among patients who had already failed to respond to standard treatment with cisplatin and etoposide. The study was conducted on 42 patients with refractory disseminated germ cell tumors. Forty patients were available for evaluation; 10 patients achieved complete responses (3 also underwent surgery for viable tumor masses). Six of the complete responders remained in remission at a median follow-up of 15 months. These results suggest that ifosfamide is a valuable addition to the standard chemotherapeutic regimen for refractory germ cell tumors. However, toxic effects were moderately severe, and included toxicity to the kidneys and the bone marrow. In three patients, kidney toxicity was sufficient to result in the termination of treatment. Twenty patients were hospitalized a total of 48 times for fever resulting from bone marrow toxicity. The authors suggest that in the future it may be possible to reduce the effects of the bone marrow toxicity through the appropriate use of growth factors. In some cases, bone marrow transplantation might be considered as an alternative. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Evaluation, Chemotherapy, Combination, Combination chemotherapy, Cisplatin, Cancer recurrence, Ifosfamide

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