Summary
The rate of reduction in the concentration of serum human chorionic gonadotrophin (hCG) following chemotherapy for germ cell tumours may follow a complex pattern, with longer apparent half-life during later stages of chemotherapy, even in patients treated successfully. The commonly used half-life of less than 3 days for hCG to monitor the effect of chemotherapy in patients with germ cell tumours of the testis may represent too simple a model. 125I-labelled hCG was injected intravenously in 27 patients with germ cell tumours and elevated hCG during chemotherapy. The plasma radioactivity and hCG concentrations were followed. During chemotherapy, the plasma disappearance of hCG showed a biphasic pattern, with an initial fast and a later slow component in all patients. Using the steep part of the hCG plasma disappearance curve, five patients who achieved long-term remission had half-lives longer than 3 days (3.6–6.8 days), whereas four out of five patients not achieving long-term remission had half-lives shorter than 3 days. After the third treatment cycle, eight patients who achieved long-term remission had hCG half-lives longer than 3 days (7.4–17.0 days). In these patients, the plasma disappearance of [125I]hCG was equivalent to that of hCG. Thus, the slow decline of hCG represented a slow plasma disappearance rather than a hCG production from vital tumour cells and could, consequently, not be used to select patients for additional or intensified chemotherapy. The concept of a fixed half-life for plasma hCG during treatment of hCG-producing germ cell tumours is inappropriate and should be revised. Difficulties in interpreting a slow decline of hCG may be overcome by comparing the plasma disappearance of total hCG with the plasma disappearance of [125I]hCG.
Similar content being viewed by others
Article PDF
Change history
16 November 2011
This paper was modified 12 months after initial publication to switch to Creative Commons licence terms, as noted at publication
References
Andreyv, H. J. N., Dearnaley, D. P. & Horwich, A. (1993). Testicular non-seminoma with high serum human chorionic gonadotrophin: the trophoblastic teratoma syndrome. Diagnos Oncol 67–71
Bosl, G. J. (1993). Prognostic factors for metastatic testicular germ cell tumours: the Memorial Sloan–Kettering cancer model. Eur Urol 23: 182–187.
Bosl, G. J. & Chaganti, R. S. K. (1994). The use of tumor markers in germ cell malignancies. Hematol Oncol Clin N Am 8: 573–587.
Bosl, G. J. & Motzer, R. J. (1997). Testicular germ-cell cancer. N Engl J Med 337: 242–253.
De Wit, R., Sylvester, R., Tsitsa, C., De Mulder, P. H., Sleyfer, D. T., Ten Bokkel Huinink, W. W., Kaye, S. B., van Oosterom, A. T., Boven, E., Vermeylen, K. & Stoter, G. (1997). Tumour marker concentration at the start of chemotherapy is a stronger predictor of treatment failure than marker half-life: a study in patients with disseminated non-seminomatous testicular cancer. Br J Cancer 75: 432–435.
Gerl, A., Lamerz, R., Clemm, C., Mann, K., Hartenstein, R. & Wilmanns, W. (1996). Does serum tumor marker half-life complement pretreatment risk stratification in metastatic nonseminomatous germ cell tumors?. Clin Cancer Res 2: 1565–1570.
Horwich, A. & Peckham, M. J. (1984). Serum tumour marker regression rate following chemotherapy for malignant teratoma. Eur J Cancer Clin Oncol 20: 1463–1470.
Kallner, A., Magid, E. & Ritchie, R. (1993). Improvement of comparability and compatibility of laboratory assay results in life sciences. Scand J Clin Lab Invest, (suppl.) 53: 42–139.
Klein, E. A. (1993). Tumor markers in testis cancer. Urol Clin N Am 20: 67–73.
Madersbacher, S., Stulnig, T., Huber, L. A., Schonitzer, D., Dirnhofer, S., Wick, G. & Berger, P. (1993). Serum glycoprotein hormones and their free alpha-subunit in a healthy elderly population selected according to the SENIEUR protocol. Analyses with ultrasensitive time resolved fluoroimmunoassays. Mech Age Dev 71: 223–233.
Motzer, R. J., Gulati, S. C., Crown, J. P., Weisen, S., Doherty, M., Herr, H., Fair, W., Sheinfeld, J., Sogani, P. & Russo, P. et al (1992). High-dose chemotherapy and autologous bone marrow rescue for patients with refractory germ cell tumors. Early intervention is better tolerated. Cancer 69: 550–556.
Motzer, R. J., Mazumdar, M., Gulati, S. C., Bajorin, D. F., Lyn, P., Vlamis, V. & Bosl, G. J. (1993). Phase II trial of high-dose carboplatin and etoposide with autologous bone marrow transplantation in first-line therapy for patients with poor-risk germ cell tumors. J Natl Cancer Inst 85: 1828–1835.
Murphy, B. A., Motzer, R. J., Mazumdar, M., Vlamis, V., Nisselbaum, J., Bajorin, D. & Bosl, G. J. (1994). Serum tumor marker decline is an early predictor of treatment outcome in germ cell tumor patients treated with cisplatin and ifosfamide salvage chemotherapy. Cancer 73: 2520–2526.
Stevens, M. J., Norman, A. R., Dearnaley, D. P. & Horwich, A. (1995). Prognostic significance of early serum tumor marker half-life in metastatic testicular teratoma. J Clin Oncol 13: 87–92.
Toner, G. C., Geller, N. L., Tan, C., Nisselbaum, J. & Bosl, G. J. (1990). Serum tumor marker half-life during chemotherapy allows early prediction of complete response and survival in nonseminomatous germ cell tumors. Cancer Res 50: 5904–5910.
Zon, R. T., Nichols, C. & Einhorn, L. H. (1998). Management strategies and outcomes of germ cell tumor patients with very high human chorionic gonadotropin levels. J Clin Oncol 16: 1294–1297.
Author information
Authors and Affiliations
Rights and permissions
From twelve months after its original publication, this work is licensed under the Creative Commons Attribution-NonCommercial-Share Alike 3.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/3.0/
About this article
Cite this article
Christensen, T., Engbaek, F., Marqversen, J. et al. 125I-labelled human chorionic gonadotrophin (hCG) as an elimination marker in the evaluation of hCG decline during chemotherapy in patients with testicular cancer. Br J Cancer 80, 1577–1581 (1999). https://doi.org/10.1038/sj.bjc.6690565
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.bjc.6690565
Keywords
This article is cited by
-
Early prediction of treatment response to high-dose salvage chemotherapy in patients with relapsed germ cell cancer using [18F]FDG PET
British Journal of Cancer (2002)
-
Validation of 125I-hCG as a marker for elimination of hCG and stability of 125I-hCG after in vivo injection in humans
British Journal of Cancer (1999)