Criteria for Response to Therapy in a Patient with a Germ Cell Tumor

 

Serum markers elevated in patients with germ cell tumors:

(1) serum HCG (in U/L = mU/mL))

(2) serum alpha fetoprotein (AFP, in ng/mL = µg/L))

 

Physical Tumor	Serum Markers	Response
completely gone by all measures; no evidence of residual disease	reduced to normal range	complete remission
residual tumor with reduction in radiologically measurable disease by > 50%	reduced to normal range	partial response, marker negative
residual tumor with reduction in radiologically measurable disease by > 50%	still above normal	partial response, marker positive
	> 90% reduction (but still above normal)	partial response, marker positive
residual tumor with increase in radiologically measurable disease by > 25%	increase > 10%	progression
residual tumor with radiographically measureable disease reduced by < 50% or increased by <= 25%	above normal AND not increased by > 10% AND not reduced by > 90%	stable disease

 

where:

• I am not sure if classification can be done on the basis of serum markers alone (in the case of partial response marker positive and progression).

 

Stable disease is any response that does not fit into the remission, partial response or progression categories.

 

Subclassification of complete remission:

(1) clinical: no radiologic evidence after chemotherapy alone

(2) pathological: complete resection of tumor with no pathologic evidence of residual disease. Vaena et al refer to "no evidence of disease - teratoma" for a patient with complete surgical resection with residual tumor showing only mature teratoma.

(3) surgical: complete resection of all tumor without evidence of residual disease

 

Vaena et al specified that a complete response required no evidence of disease and normal serum markers for at least 1 month.

 

A favorable response to therapy involved either:

(1) complete remission

(2) partial response, marker negative