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Tumor Marker Rise during Second Course of High-Dose Chemotherapy in Cancer: Outcome Analysis

Mukta Pant-Purohit, Mary J Brames, Rafat Abonour and Lawrence H Einhorn

Purpose: To retrospectively analyze the frequency and outcome of hCG and AFP rise at start of or within 1 week after initiation of second course of high-dose carboplatin and etoposide chemotherapy (HDCE) in patients with relapsed or refractory germ cell cancer.

Patients and methods: A single-institution review of 391 patients treated with HDCE and peripheral blood stem cell rescue from Feb 1996 to December 2010 was performed. Each patient received 2 consecutive courses of 700 mg of carboplatin per square meter of body-surface-area (BSA) and 750 mg of etoposide per square meter of BSA, each for 3 consecutive days, and each followed by autologous stem cell infusion. The second HDCE was administered 3-4 weeks after the first course. Weekly tumor markers were obtained.

Results: 25 of 391 (6.4%) patients were noted to have rising hCG, AFP or both at initiation or within 1 week of second course of HDCE. Fourteen patients had hCG rise (median 48.7 mIU/mL; range 3.2 – 8.863) and 11 AFP rise (median 18.3 ng/mL; range 4.2 - 1,018.8). Twenty-four of 25 patients had a subsequent decline in tumor marker with second course HDCE. Seven of 25 (28%) patients are continuously disease-free at median followup of 69 months (range 28-124 months).

Conclusion: Tumor marker rise during second course of HDCE is uncommon. Although it represents an adverse prognostic variable, cure is still possible with institution of second course of HDCE.